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

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. 

 

What if December 12th were repeated in the May mayorals?

Chris Game

I’m not unrealistic.  I didn’t expect the Queen in the few hundred words written for her Queen’s Speech to chatter on that much about local government and councils – and she didn’t.  I did think, though, they might get some attention in the 150-page Background Briefing Notes.  But, no.  In the literally brief note on English Devolution (pp.109-10), ‘councils’ per se aren’t mentioned.  The search did, however, make me realise how crowded it’s going to be out there, as “each part of the country” gets “to decide its own destiny”.

The Government “remains committed” to the Northern Powerhouse, Midlands Engine, Western Gateway, and, I think, the Oxford-Cambridge Arc. The 38 Local Enterprise Partnerships certainly aren’t going anywhere soon.  Indeed, they may well be hoping to get their hands on the UK Shared Prosperity Fund that will replace EU Structural and Investment Funds. And quite possibly too on the PM’s own £3.6 billion Towns Fund, with, for starters, 100 Town Deal Boards, chaired “where appropriate” by someone from the private sector.

Then there are the UK Government agencies that Johnson wants to relocate out of London, with their existing civil servants or any who aren’t “super-talented weirdo” enough to pass the Dominic Cummings test.

The one democratic element of this increasingly crowded world that does receive more than a passing mention in the Briefing Notes are Mayoral Combined Authorities (CAs) and City Region Mayors, with talk of increasing the number of mayors and doing more devo deals. There weren’t many stats in this section, but one did catch my eye: “37 per cent of residents in England, including almost 50 per cent in the North, are now served by city region mayors with powers and money to prioritise local issues.”

With CA mayoral elections coming up in early May, I did a few quick sums. The current party split among the nine elected mayors, including London, is 5-4 to Labour.  The population split, though, is close to 3-1, with Mayor Andy Street’s West Midlands contributing over half the Conservative total.  And Street’s victory over Labour’s Siôn Simon in May 2017 was knife-edge: by 0.7% of the 523,000 votes cast.

I sense you’re ahead of me.  If, in the coming May elections, West Midlands voters were to return a Labour mayor, leaving Conservative mayors governing, say, barely one in eight of that 37% of residents, would a Conservative PM still be as enthusiastic about devolution to mayoral CAs?  We know for near-certain that Theresa May wouldn’t have been, but Johnson, as on most things, is less predictable. 

Anyway, it seemed worth asking: what would happen in the May mayoral elections, which include London this time, if everyone voted just as they did in December’s General Election?  Happily, Centre for Cities’ Simon Jeffrey got there first, so the stats are his, the interpretation mine.

First, though, a quick reminder of the broader context of those 2017 mayoral elections, and what’s happened since.  When Andy Street launched his bid for the West Midlands mayoralty, and even when he was officially selected as Conservative candidate, there looked like being only five of these new CA mayors.

Moreover, all five – Greater Manchester, Liverpool and Sheffield City Regions, Tees Valley, and West Midlands – might easily, given their borough councils’ political make-ups, have produced Labour ‘metro mayors’.  Whereupon, it seems likely that, to say the least, Prime Ministerial enthusiasm for serious devolution to metro mayoral CAs would have waned somewhat.

However, things changed. Sheffield’s election, following a dispute over the inclusion of Derbyshire local authorities, was postponed until 2018, and two far less metropolitan (and more Conservative-inclined) CAs were established – West of England (Bristol) and Cambridgeshire & Peterborough – just in time for the 2017 elections. 

With Tees Valley also going Conservative, Prime Minister May saw an initially possible 0-5 redwash turn into a remarkable 4-2 triumph – as reported on this blog. The political merits and possibilities of devolution, particularly to the West Midlands – bearing in mind that Labour overwhelmingly controlled Birmingham Council and formed the largest party group in five of the other six boroughs – suddenly seemed much more obvious.

Since then, though, the pendulum has swung. A reconfigured Sheffield CA and new North of Tyne CA have both elected Labour mayors, evening up the CA party balance at 4-4, but giving a score among the now ‘Big 5’ metros (populations over 1.3 million) of 4-1 to Labour, including Greater London Mayor, Sadiq Khan.

Jeffrey’s sums show that Mayor Khan would be re-elected easily, likewise Labour’s Steve Rotheram in Liverpool.  In Greater Manchester, Labour’s Andy Burnham would be re-elected, but with a considerably reduced majority.  And the collapsing ‘red wall’ would have more than doubled Conservative Mayor Ben Houchen’s majority in Tees Valley.

And so to the West Midlands, which also saw plenty of “Red wall turning blue”, “No such thing any more as a Labour safe seat” headlines. It felt as if the Conservative vote had to be ahead, and it was … but by under 3,000 out of 1.18 million, or 0.2%! 

Yes, even replicating the Conservatives’ most decisive electoral win for a generation, it could be that tight.  And, if it were Labour’s eventual candidate who edged it, that would see Labour metro mayors as the elected heads of government in London and all four largest city region CAs, representing nearly a third of the English population. ‘Everything still to play for’ seems an understatement.

Chris Game - picChris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.

Christopher Watson

John W Raine

It was deeply saddening to learn of the passing of a very dear friend, Chris Watson. I first met Chris in the mid 1970s when I was working in my first job, as a housing and planning researcher at the Government’s Building Research Establishment (an outpost of the then Department of the Environment). Chris used to visit my unit there from the University of Birmingham’s Centre for Urban & Regional Studies to meet with some of my colleagues, who were involved in a joint research project. From my first encounter I found Chris to be one of the very best – so patient and yet decisive, so knowledgeable yet modest, so respectful yet authoritative.

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Three years later, when I obtained my next job, at the University of Birmingham’s Institute of Local Government Studies, I found myself in the same building as Chris, just one floor apart, and with our respective departments working closely together and sharing a specialist library and other common facilities and space. Indeed, he was one of the members of staff with whom I first struck up a rapport, and although we did not thereafter do much joint work together, I saw a lot of him and always welcomed our interactions in the corridors; appreciated his genuine interest in all that I was doing; and greatly valued his sheer warmth of personality and willingness to share time with me – as with everyone who knew him.

Much later, in the late 1990s, when I had become Director of my Institute at Birmingham, and Chris was leading for the University on International Affairs and directing the newly established Japan Centre, I had the privilege of working more closely with him in arranging a number of study visits at the University for distinguished colleagues from Japan and other parts of Asia.

In summing up, I can say that, without a doubt, I owe a great deal in my career and personal development to Chris Watson – who acted informally as a mentor for me from my start at Birmingham; and whose warmth of personality, generosity of time for others, and exceptional modesty with regard to his many and diverse accomplishments, have been a model to me – and I am sure to all others who have had the good fortune to get to meet and know him. It is also a touching coincidence that my own middle name is Watson – this having been my mother’s maiden name, and of course that of my maternal grandparents!

Chris Watson is greatly missed but my memories and gratitude for his friendship will endure.

john raine

John Raine is Professor of Management in Criminal Justice at INLOGOV. He has been involved in criminal justice research, consultancy and teaching at Birmingham for some twenty-five years and has a strong track record of commissions for the Home Office, Lord Chancellor’s Department/Department for Constitutional Affairs/Ministry of Justice on aspects of policy and practice within the criminal (and civil) justice sectors.

The INLOGOV General Election Maxifesto Quiz

Chris Game

There were two prompts for this blog. The first was the politest of enquiries from the recently returned INLOGOV Blog Manager, which was easy enough to deflect. Shortly after doing so, however, while reading through one of the parties’ election manifestos – as you do – I came across ‘dibs’, a word I don’t recall crossing either my lips or barely my consciousness for a good half-century or so.

Back in my distant childhood there was much dibbing – and dybbing. On my father’s allotment I would make holes with my own potato dibber. As cub scouts, we would be enjoined every Friday evening by the ‘Old Wolf’ Akela to ‘Dyb, Dyb, Dyb’ (‘Do Your Best’), responding of course that we would indeed ‘Dob, Dob, Dob’. Back home, if there was any scarce desirable to be shared, like recently de-rationed sweeties, my younger sister Jennifer and I would compete for ‘first dibs’ (1).

In the ensuing decades, though, dibbing disappeared completely from my life. Yes, I recall registering the existence of the very top-end-of-the-market 1stdibs fine art dealership, but my INLOGOV salary discouraged closer interest. I remember being intrigued, therefore, by the context in which it did re-enter my personal/public policy world, and was fascinated again to see it an election manifesto.

So much so that I felt an urge to share the news, and decided to sneak it surreptitiously into an INLOGOV Election Maxifesto Worthy Pledge Quiz – not exactly an established tradition, but for which there is a kind of antecedent.

A Worthy Pledge is best explained by what it isn’t. It’s not one of those a major party either wants to, or fears might, create headlines and win or lose it loads of votes – and which are likely to be known to or guessable by readers of this blog anyway. Worthy Pledges are the add-ons. Not exactly window-dressing, because so relatively few wavering voters will even glance at, let alone open, these windows. They’re mostly imprecise pledges, or often just hopes – so loosely phrased that accountability of anyone, ever, is out of the question.

They are, however, the main reason why the average length of the major parties’ 2019 maxifestos – around 25,000 words (without ancillary ‘costings documents’) – is roughly four times the total length of ALL THREE major parties’ manifestos in 1951 (Thackeray and Toye, 2019). Nearly 83% of voters turned out in that election – the last time a General Election turnout topped 80% – and, while we don’t know how many of them had read those minifestos, it’s surely a fair bet that it’s more than will have thumbed through the 60-100 page compilations this time.

Here, then, listed alphabetically, is the 2019 Local Government Maxifesto Worthy Pledge Quiz.

Which party (Conservative, Labour, Lib Dem, Green, Brexit) pledges to …?

  1. Abolish both student loan interest and the target to push 50% of young people into Higher Education.
  2. Devolve full control of Right-to-Buy to local councils.
  3. Encourage councils to build more beautiful architecture.
  4. End rough sleeping within five years.
  5. Enshrine a legal right to food in law.
  6. Establish a £150m. Community Ownership Fund to help local people take over civic and community assets under threat, including football clubs and post offices.
  7. Establish a Royal Commission to develop a public health approach to substance misuse, focusing on harm reduction rather than criminalisation.
  8. Explore ways to tackle the problem of grade inflation in higher education courses (sorry, that’s more for us in the UoB!).
  9.    Increase central government funding to councils by £10 billion a year.
  10. Introduce a levy on overseas companies buying housing, and give local people ‘first dibs’ on new homes built in their area.
  11. Launch the biggest ever pothole-filling programme.
  12. Legislate to require councils to switch from a Cabinet system to a Committee system.
  13. Provide 35 hours a week of free childcare, from the age of 9 months.
  14. Replace Police and Crime Commissioners with police boards made up of local councillors.
  15. . Stop bank branch closures and ban ATM charges.

Of course, the inherent problem with these kinds of exercises is where to list the answers. It may be that the Blog Manager can come up with something brilliant, but in case he can’t, I’ll witter on for another couple of sentences, then list them at the end – confident that you won’t have cheated and read ahead.

So, how many of you got the ‘first dibs’ pledge? It’s Labour’s, of course – a straight steal from Mayor Sadiq Khan’s attempt to give Londoners the first chance to buy new homes priced up to £350,000 before foreign investors can get their hands on them. A bit like Jennifer, after sweets came off rationing in 1953, except statistically her chances were massively better.

Finally, since you were no doubt wondering, one possible origin of ‘first dibs’ is an ancient children’s game played (by ancient children) with pebbles or sheep’s knucklebones known as ‘dibstones’.

The answers: 1. Brexit Party; 2. LD; 3. Con; 4. Trick question – Con + Lab; 5. LD; 6. Con; 7. Lab; 8. Con; 9. Green; 10. Lab; 11. Con; 12. Green; 13. Green;                    14. LD; 15. Lab.

Chris Game - picChris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.

Public leadership as a call to action

Dr. Catherine Durose

In uncertain and challenging times, an important part of the role of leadership in public services can play lies in offering a narrative that helps people to understand what may be happening and mobilise their support to address the problem. But what tools can public leaders use to do this effectively?

Borrowing from the civil rights movements and grassroots and labour organizing, public narrative is a skill aiming to motivate others to join you in action. Associated with the work of Marshall Ganz at Harvard’s Kennedy School of Government, public narrative offers a framework to ‘show not tell’ how shared experiences reveal our shared values. This emphasis on leadership as a form of ‘sense making’ was the focus for discussion for a panel of local public leaders, who joined our Masters in Public Administration students last week. We invited leaders to share with our students, their motivations to lead.

Joining us fresh from the ‘momentous victory’ in the Birmingham care workers dispute, UNISON Regional Organiser, Ravi Subramanian drew a powerful link between his first-hand experiences of racism growing up in 1970s Grimsby and this recent campaign. Ravi reflected on the ‘golden thread’ of not being listened to by those in power, and the need to effectively organise to challenge this.

Claire Spencer, Acting Head of Inclusive Growth and Public Sector Reform at West Midlands Combined Authority, is developing strategy for how economic growth can benefit all in the city-region. Claire drew on her family experiences of displacement due to conflict to reflect on her own privilege and desire for everyone to have the safety and opportunity to thrive and how this has informed her journey as a leader.

Sophie Wilson, Director of Research for BVSC, an organisation that champions and supports the voluntary sector in Birmingham, reflected on how her early experiences of volunteering in a women’s refuge brought home the complex and inter-connected nature of issues such as homelessness, substance misuse and mental health, that has shaped her career as a leader in the third sector. Sophie shared both the emotional labour involved in leading through periods of change and uncertainty, and the opportunity that this offered for personal growth and learning.

By sharing their narratives with our students, these leaders humanised what it means to lead in public services, not only the moments of self-doubt and unlikely trajectories, but how early experiences can inform and catalyse leadership aspirations, and mobilise others to join you.

Catherine Durose is a Reader in Policy Sciences at the Institute of Local Government Studies and recent Director of Research and Knowledge Exchange for the School of Government at the University of Birmingham. Catherine is a leading expert on urban governance and public policy, interested in questions of how we initiate and facilitate inclusive decision-making and social change in urban contexts. She has sought to address this question in her research, with particular focus on issues such as intermediation, participation, decentralisation and democratic innovation.

Socially smart cities: Making a difference in urban neighbourhoods

Alison Gilchrist

The ‘smart cities’ movement has emphasised the contribution that technologies can make to tackling complex problems at the interface between urban institutions and the people who live and work in cities. Policy and funding has directed attention to issues such as traffic movement, air quality, social care provision, public participation, etc. within complex systems of micro-decision making and service delivery that need smooth and speedy co-ordination of demand and response. Using online or artificial intelligence, smart city models harness the latest technological developments to integrate information across a range of sources and to mobilise big data to broker diverse interests and deliver services on the ground.  But this is not enough to solve the major challenges facing many urban neighbourhoods.

Recent research in four northern European cities has revealed the crucial role played by ‘socially smart’ individuals working to improve life for the residents of challenging, but vibrant, neighbourhoods. These ‘smart urban intermediaries’ (SUIs) work with communities to devise ‘win-win’ strategies that tackle problems that both public authorities and private market forces find difficult to address.

The research team worked closely with forty individuals over nearly two years: observing their practice, exploring motivations and reflecting on some of the factors that enabled or obstructed their work. In many ways the SUIs are all different, with different motives and approaches, tailored to different times and circumstances. Nonetheless, they do have common practices and traits. The project compared experiences in similar neighbourhoods and found remarkable overlaps between how the smart urban intermediaries operate and what drives their commitment to social progress. Most have dedicated many years to improving the lives of the most disadvantaged residents of specific areas.  Two examples illustrate the courage and creativity of SUIs, using their networks to assemble the people and resources needed to improve life for residents.

In Copenhagen, a brave tenant led a campaign to rid her area of gangs openly dealing drugs and using knives and guns to threaten anyone who got in their way. She mobilised her neighbours through street protests and organised community actions to reclaim community spaces. The group also lobbied the police and city mayor to take more responsibility and to help residents to defend the neighbourhood against criminal activities.

Health problems among the Asian communities in Birmingham have caused concern for many years. A local initiative, the Saheli hub led by a community worker, has developed a range of fitness and adventure activities for women of all backgrounds to try out new experiences and challenges, such as cycling, running and kayaking.

The SUIs are passionate about improving life for their neighbours and challenging social injustices.  They nurture social relations and use these to bring together ideas, assets and expertise to develop projects that meet local needs and aspirations. This is possible because the smart urban intermediaries are trusted and respected. They invest time and effort in a web of connections with people who can provide advice, encouragement and practical help, often for free or very little financial cost. By working across sectors, traditional policy and institutional divisions, SUIs can be innovative, but sometimes struggle to maintain momentum because funding runs out, volunteers move on or they themselves experience ‘burn out’.

So, how can this vital, but hidden, role of SUIs be supported? Policy-makers and funders  might better recognise and respect their contribution to neighbourhood lifeThey might help to sustain the work of SUIs who are valued locally but struggle to make ends meet. And finally, they might invest in cross-sectoral initiatives that renew and align what is out there already. Smart cities rely on the latest technologies to enhance services and transform infrastructure. They also need socially smart urban intermediaries who understand local conditions and can spark community action around specific issues. Until that connection is made, smart city strategies will have a people-shaped void at their centre.

Alison Gilcrist

Alison Gilchrist is Research Fellow at INLOGOV as part of the Smart Urban Intermediaries project. Formerly Director of Practice development at the UK’s Community Development Foundation.

 

 

This blog originally appeared on the Smart Urban Intermediaries website. With thanks to them for allowing cross-posting. The views expressed in this blog are those of the author and not INLOGOV or the University of Birmingham.