Scrutiny

The national political tremors have settled. Let’s re-focus on local health scrutiny

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Cllr. Ketan Sheth

There was a lot of national media commentary and coverage about the role of the NHS at the recent General Election, which was unsurprising given all the commitments major political parties were making: boosting NHS funding, more doctors and extra GP appointments, rebuilding hospitals, and so on.

However, I think that members of overview and scrutiny committees – of all political parties – know that the NHS in particular and health in general are always a major issue in their areas regardless, not just because of the casework we receive from constituents or because health and the NHS tend to fill up a lot of the space on the work plans of our scrutiny committees.

Firstly, local government is part and parcel of the structure of the NHS in many localities, with Directors of Public Health and Directors of Adult Social Care sitting on the executives of Clinical Commissioning Groups. And, let’s not forget that many elected councillors are involved outside the local authority in the governance structures at a Board level of many of their local NHS providers (I will declare an interest as I am a Lead Governor of Central and North West London NHS Foundation Trust). In local government, we have a view of the NHS from the root up and dare I say probably a more detailed picture than those operating at a national level or, to use today’s jargon, a ‘granular’ picture, which shows that every area has its own strengths and weaknesses that may or may not align to the national picture.

So, now we are settling back into the business of ordinary scrutiny committees there are three areas which, drawing on my own experiences, I think many healthy overview and scrutiny committees will be focusing on in 2020. They look a little different to the recent national debate.

Firstly, the quality of services, particularly of primary care, is a growing area of importance alongside access to services. The Care Quality Commission publishes ratings for each of the primary care providers in each area; it’s always worth keeping up to date with the local picture, in particular how ratings change. What you will want to see is an improvement in these ratings, and fewer GP providers being placed in special measures as a result of an inadequate CQC rating. If it’s heading in the opposite direction in your area, it might be time to ask why.

Secondly, working at scale is increasingly the big challenge for the NHS. On the commissioning side in north-west London there are plans to merge eight separate CCGs into one body by April 2021. That will mean a single operating model, and I assume some commissioning arrangements, operating at scale, commissioning services across many different boroughs. That’s something we will be tracking with care.

Finally, workforce is an issue which is frequently raised at health overview and scrutiny meetings. We’ve heard a lot about problems nationally of recruiting to specialist posts, as well as vacancy rates for nurses. But is it time to ask about the local pressures on recruitment and retention in the hospitals for the big provider trusts in your area?

So, now the national political tremors have settled let’s re-focus on local health scrutiny issues for 2020. Who knows, they may be very different to the national picture.

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Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. 

 

All in A Day’s Work: Mental Health Provision, Wellbeing and Scrutiny in Brent Council

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Cllr. Ketan Sheth

As Chair of the Community and Wellbeing Scrutiny Committee at Brent Council, Cllr. Sheth has a behind the scenes look at the workings of local government. Here he shares his experience in trying to improve Brent’s mental health provision and his views on what good local authority overview and scrutiny looks like. 

One in four people will experience mental ill health at some point in their lives – so it is likely all of us will directly or indirectly need support from the valuable services that support people to recover and to remain resilient.

Mental health – a once under-reported and some would say under-valued aspect of our health and wellbeing – has been making headlines recently and is a stated national priority. Earlier this year the Prime Minister announced plans to transform mental health services with a particular focus on children and young people. This was subsequently followed by an announcement last month by the Health Secretary of a plan to create 21,000 new posts, investing £1.3bn by 2020. Again, the commitment to mental health services for children and young people was affirmed.

This brings a welcome focus given children and young people’s mental health and wellbeing can ultimately shape their life chances and outcomes. So now we must think about how we – as a local authority overview and scrutiny committee – understand what is going on behind the headlines and – as elected councillors – continue to shine the spotlight locally.

Scrutiny work that adds a real value and makes a positive difference to local residents’ lives must remember a number of important factors: are elected councillors supported to carry out a meaningful review? Do they understand how to capture the service model? Do they understand how to draw out the challenges to effective delivery of that model? Do they have the tools and information they need to be responsive local decision makers?

In Brent, my Community and Wellbeing Scrutiny Committee recently went behind those headlines to better understand mental health provision for children and young people across Brent and to see how we might add value to the current service model. A Task and Finish Group on Child and Adolescent Mental Health Services (CAMHS) was set up to review this complex area, and their report makes for very interesting read.

The task group was put in place to gather evidence – qualitative evidence from face-to-face interviews and research, and quantitative data and this was done alongside NHS Brent CCG, local health providers, schools and further education representatives and community representatives. I want to highlight two things my committee learnt in undertaking this work.

Firstly, the involvement of young people in this research was vital. Let’s face it, elected councillors in a local authority tend to be far older than the demographic we were seeking to reach, so it was incredibly helpful to have the input and perspectives of young people. We appointed a former member of Brent Youth Parliament (now a student at King’s College London) and they brought an excellent viewpoint to the task group’s work and deliberations.

Secondly, it was essential we recognised and embraced the complexity of this area. CAMHS is a complex and challenging subject for overview and scrutiny members because it cuts across local government and health responsibilities. Whilst this is excellent news for integrated care, it means you must be able to grasp and work across a range of people and organisations. You must also recognise the child or young person and their family and carers are a vital part of this system and network of care, and understand their perspective as well.

Effective scrutiny can be a powerful vehicle for change if committee members can stand back and really understand what is happening across local government and health services. If we are honest, overview and scrutiny committees nationally have varying relationships with public sector colleagues; however, in Brent, my committee’s relationship with NHS Brent CCG and wider health services is a good one. We try to be constructive and fair in forming our recommendations, especially in areas where we think things could be done differently and outcomes could be improved.

We have now made our recommendations to the Brent Council Cabinet and NHS colleagues and will monitor progress as a result. In Brent we will ensure mental health for adults and children and young people remains on the agenda, irrespective of the headlines.

To read the CAMHS task group report, visit http://www.brent.gov.uk/scrutiny.

 

 

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Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

The Tale of Kensington’s Secret Cabinet

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Philip Whiteman

Last week, I wrote about the potential scope for intervention measures by the Secretary of State against Royal Borough of Kensington and Chelsea (RBKC) following their authority’s inability to provide leadership after the Grenfell Fire Disaster.  The adverse publicity surrounding the authority and its handling of the crisis should have provided a wake-up call in terms of leadership and how it manages its relations with wider public.  So it was somewhat surprising that the Authority remains in hot water following an attempt to stop the public from attending a scheduled cabinet meeting, including a legal judgement overturning that ban and scorn from Downing Street.

As most monitoring officers and councillors will be aware, there are strict rules governing public attendance. So it is surprising that RKBC attempted to block public access.

Council meetings and committee meetings are formal events, not social occasions. They have a clear purpose – to make decisions – and are not just talking shops. Furthermore, they are public events; the meetings must be advertised and the press and public have a right to observe how the council operates. Exceptions are when sensitive issues are discussed (such as legal, contractual or staffing matters) and then the council can agree to exclude the press and public for just that item of business.  They are not to be closed to the public at a council leader or monitoring officer’s whim.

The rules governing public access are defined under Section 100(A)(4) of the Local Government Act 1972, which states that the public (including the press) may be excluded from Council meetings if exempt information relating to one of the following paragraphs of Schedule 12A to the Act is likely to be disclosed. Section 12A sets out the following matters which shall be considered as private:

  • Para 1 “Information relates to a particular employee, former employee, applicant to become an employee, office holder, former office holder or applicant to become an office holder.”
  • Para 3 “Information relates to a particular occupier or former occupier of, or applicant for, the Council’s accommodation.”
  • Para 4 “Information relates to a particular applicant for, recipient or former recipient of a service”.
  • Para 5 “Information relates to a particular applicant for, recipient or former recipient of financial assistance”.
  • Para 7 “Information relates to the financial or business affairs of a particular person.”
  • Para 8 “Information relates to the amount of expenditure proposed to be incurred under a particular contract for the acquisition of property, or the supply of goods or services.” (see footnote 1 below)
  • Para 9 “Information relates to terms proposed or to be proposed in the course of negotiations for a contract for acquisition or disposal of property, or the supply of goods or services.” (see footnote 2 below)
  • Para 10 “Information relates to the identity of the Council as offering a particular tender for a contract for supply of goods or services.”
  • Para 11 “Information relates to current or contemplated consultations or negotiations in connection with a labour relations matter arising between the Council and employees or office holders of the Council.” (see footnote 3 below)
  • Para 12 “Information relates to instructions to, or opinion of, Counsel and advice received, information obtained or action to be taken in connection with legal proceedings by or against the Council, or the determination of a matter affecting the Council
  • Para 13 “Information would reveal a proposed notice, order or direction under an enactment.” (see footnote 4 below)
  • Para 14 “Information relates to action taken, or to be taken, in connection with the prevention, investigation or prosecution of a crime.”
  • Para 15 “Information would reveal identity of a protected informant.”

Under these rules, it is possible that the authority deemed paragraph 12 as grounds to restrict public access.  Yet, it is an authority that is facing an internal crisis as well as having to handle the aftermath of Britain’s most serious fire this century.  So it is possibly beggar’s belief that they attempted to exclude public access.

Not only are the public to be admitted to public council meetings unless exempted by Section 12A, but they are also subject to further restrictions on information they can withhold by means of The Local Authorities (Executive Arrangements)(Meetings and Access to Information)(England) Regulations 2012.  The 2012 regulations created a presumption that all meetings of the executive, its committees and subcommittees are to be held in public (regulation 3) unless a narrowly defined legal exception applies. A meeting will only be held in private if confidential information would be disclosed, or a resolution has been passed to exclude the public because exempt information is likely is be disclosed, or a lawful power is used to exclude the public in order to maintain orderly conduct at the meeting (regulation 4).   In the past councils could cite political advice as justification for closing a meeting to the public and press, or state that decisions being made were not ‘key decisions’. The new regulations create a presumption that all meetings of the executive, its committees and subcommittees are to be held in public. Clearly, in the instance of any decision related to Grenfell, it would have to be regarded as a ‘key decision’.


Philip Whiteman is a Lecturer at the Institute of Local Government Studies.  He has research interests in the impact of central government and regulators on the role, service delivery and performance of local government and other local bodies.  

Do we want fewer councillors, or should we make better use of those we have?

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Andrew Coulson

“What are councillors for?” was the question asked at a recent INLOGOV event.

“To take the rap for cuts” was one of the responses.

“We should have fewer councillors, in large single-member wards” was another response. To which the reply came back, sharply, that this would lead to lower quality of councillors, as those who were entrenched in safe seats refused to move on. Young people, women, and people from minorities would find it even harder to get selected. If what we need is a high quality of councillors then the only reliable way of achieving this is to have a large pool of councillors, from which the best can be chosen for office.

The county council elections also provide food for thought on these matters. In six of the counties where there have been boundary changes these will result in fewer councillors (in most of these cases the Boundary Commission was responding to proposals from the councils concerned): Bucks -8, Glos -10, Northants -16, Oxon -11, Somerset -3. This is is a situation where we already have by far the highest ratio of residents to councillors anywhere in Europe – and the more residents a councillor is supposed to represent, and the more distinct communities, the harder it becomes to properly represent local feelings and interests.

So what are councillors for? OK, they are a channel for local residents with grievances in their wards, opposing planning applications (on rare occasions supporting them), and, when opportunities arise, working with local activists in their communities, or taking a lead themselves, to create new initiatives, new responses to situations and needs, or to openings created by new legislation. But, if they are to go beyond this and engage directly with senior officers and act strategically, then a certain level of knowledge is needed and plenty of confidence as well. And the way local government works at present does little to encourage this – hence, perhaps, the complaints that most councillors are redundant and that we should have fewer of them.

The Local Government Act 2000 gave almost all the strategic decision making to small cabinets or individual mayors or cabinet members, or, increasingly, to paid officials (“officers” – does not the military language say it all?) It removed most of the powers of the Full Council, and with that most of the opportunities for councillors who are not members of the cabinet to contribute to strategic decision-making. With decisions taken elsewhere, full council meetings degenerated, often into slanging matches between the main political parties structured (if that is the word) around resolutions which reflect national priorities or party campaigns.

Yet a council should be a Parliament for its area. It is the demonstration of the benefits which can come from the right, expressed in the European Charter of Local Self-Government, for a town or village to elect its own representatives to run its own affairs, to the greatest extent that this is possible, and with sufficient resources to make real choices. That means debates on local issues, discretion over budgets, and votes when appropriate, giving councillors the power to give their local leaderships a bloody nose when they deserve it.

Scrutiny should be a facility to assist the full council in its role of holding the executive to account (and other agencies active in the local area also). This corresponds to the role of select committees in the Westminster or Cardiff parliaments. These are best known for their set-piece occasions when they hold bankers, the chief executives of multinational companies, senior civil servants, or ministers, to account. It is often forgotten that their bread and butter work is the collection of evidence on matters of policy or public administration, which is enshrined in detailed reports – more consultancy or research than ritual humiliation for the TV cameras or a court of law. It is that kind of detailed investigation that scrutiny committees in local government do best, working across party allegiances to discover the truth and offer recommendations on the best way forward.

The Local Government Act 2000 put scrutiny in hoc to cabinets, with no mention of the full council. This weak position is further entrenched when scrutiny officers double as policy officers supporting the Cabinet (it is no secret that scrutiny, like the select committees, depends profoundly on able and independent-minded officers or clerks who can turn the often rambling questionings of politicians into sharp, focussed and often critical reports and recommendations).

That is why a small but increasing number of councils are returning to decision-making by all-party committees. Not because decisions are made more quickly that way (though councils can make quick decision when they have the will to). Not because it makes a single person responsible for a decision (though the chairs of strong committees are often at least as powerful as cabinet members). Not because it allows decisions to be made in public (any more than do cabinets, where the real decisions are made in private before the public meetings, making the public meetings almost redundant). But because it involves all the elected councillors in decision-making, enables those newly elected to participate from Day 1, keeps officers and committee members on their toes, and properly respects the expertise of Opposition councillors and their rights to ask questions and to probe the logic of officers.

Where you have government by committees, no-one any longer questions what councillors are for.

andrew coulson blog

Dr. Andrew Coulson is Lead Consultant on Overview and Scrutiny at INLOGOV, University of Birmingham, with wide experience of Overview and Scrutiny. He has recently launched one of the first assessed qualifications on the subject. His further research interests include partnerships and governance, economic and environmental strategies, and local government in Central and Eastern Europe.

On 27 June INLOGOV will be holding its third day-workshop on Governance by Committees. Many of the councils who changed their governance arrangements in April 2012 will be present, along with other councils who will by then have changed. This is a unique opportunity to consider the merits of the change. For further information see the advert and booking form.