Public performance and delivery

Mission Possible? 

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Jason Lowther

With under 700 days to the next UK general election, political parties are busy developing their manifesto documents.  In February, Labour leader Keir Starmer made a major speech laying out his “five missions for a better Britain”.   How do these five missions relate to local government?  And is the turn to “mission driven” government likely to work?

The five missions vary in their level of specificity and challenge.  Securing “the highest sustained growth in the G7, with good jobs and productivity growth in every part of the country…” is a little vague but likely to be difficult, especially given we are currently ranked 6 out of 7 in terms of output per worker.  Mission #2, “make Britain a clean energy superpower”, accelerating the move to zero-carbon electricity from 2035 to 2030, is specific but very challenging.  Mission #3, reform of health and social care and reducing health inequalities, will require a re-focus from secondary (hospital) care to social care and addressing the social determinants of health.  Mission #4 is about community safety, and likely to involve more community policing.  Finally, mission #5 is to “break down the barriers to opportunity at every stage” through reform to the childcare and education systems.

Local government potentially has important roles in each of the five missions.  Local education, skills and economic development functions will be critical to improving productivity.  On energy, Net Zero requires at least a doubling of electricity generation by 2050, from decarbonised sources.  Decarbonisation strategies need to be place-based, taking account of the geography, building types, energy infrastructure, energy demand, resources and urban growth plans.   We’ve recently argued here for the key roles of councils in this area. 

Turning to health and care services, local government clearly has leading roles – including ensuring place-based planning to address the social and behavioural causes of health inequalities.  Analysis by the Liverpool and Lancaster Universities Collaboration for Public Health Research in 2021 concluded: “investment across the whole of local government is needed to level up health including investment in housing, children’s, leisure, cultural, environmental, and planning services”.  Similarly community safety, child care and education are areas where local government could be enabled to have much greater positive impact.

Perhaps as important as the specific “missions” is the approach to governing which the party is proposing.   Labour’s document characterises this as a move from top-down, target-led, short-term, siloed approaches, to government which is more “agile, empowering and catalytic”, working across the public and private sectors, and civil society.  This, it argues, requires organising government around a shared vision, focusing on real world outcomes, concentrating on ends with flexibility and innovation concerning means, devolving decision making from Westminster, increasing accountability including central and local data transparency, and adopting long-term preventative approaches including greater financial certainty for local areas. 

In some ways the idea of mission-driven government echoes the 1990s thinking of Ted Gaebler and David Osborne’s book “reinventing government”, which argued for a more entrepreneurial approach to the delivery of government.  Their work pointed to entrepreneurial companies setting overall missions and goals, and then leaving managers to figure out how best to deliver these – for example, by providing an overall budget for a service rather than detailed line-by-line budgets which disappear if not spent by year end.  The focus on managers rather than considering the perspective of politicians is one of the problems identified in subsequent evaluations of the reinventing government model, together with difficulties in sustaining the approach.

Mission-driven policies addressing ‘grand challenges’ of society are increasingly common, for example in the UN Sustainable Development Goals and various EU policies.  Mazzucato et al recently argued that addressing such challenges requires strategic thinking about: the desired direction of travel, the structure and capacity of public sector organisations, the way in which policy is assessed, and the incentive structure for the private, public (and I would add community) sectors. Labour’s paper makes a start (albeit at a very high level) on thinking through these areas. The litmus test, though, will be in developing the detail and how far this engages with local areas.   

Over the next few months, we will be contributing to the debate on the upcoming party manifestos with some research-informed thoughts on a variety of local government related policy areas.  If you would like to be involved in developing these, please get in touch. 

Jason Lowther is the Director of INLOGOV. His research focuses on public service reform and the use of “evidence” by public agencies.  Previously he worked with West Midlands Combined Authority, led Birmingham City Council’s corporate strategy function, worked for the Audit Commission as national value for money lead, for HSBC in credit and risk management, and for the Metropolitan Police as an internal management consultant. He tweets as @jasonlowther

Picture credit: BBC

Local government should welcome Gordon Brown’s private bills proposal

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Phil Swann

Streamlined access to local legislation must be available to help struggling councils to improve rather than rewarding those that have already done so, writes a PhD candidate in central-local government relations at INLOGOV and former director of Shared Intelligence.

In 1926 Winston Churchill, then chancellor of the exchequer, successfully opposed a private bill promoted by Bristol Corporation to establish a municipal bank in order to stop “all kinds of incompetent town councils”, particularly “socialistic” ones, from running banks. He did so despite the fact that the bill was supported by his Conservative colleague and former mayor of Birmingham Neville Chamberlain, who argued that Birmingham’s municipal bank had encouraged thrift and home ownership.

It is interesting to reflect on this dispute (not the last between these two political Titans!) in the context of the move by Gordon Brown’s Commission on the Future of the UK to promote the use of private bills by local councils. Raising the prospect of “the great cities of England” exerting similar powers to the Scottish and Welsh governments, the commission recommends a new, streamlined process enabling councils to initiate local legislation in parliament. This, the commission argues, would give councils an ability to secure the powers they need and to have a direct relationship with Parliament.

Evading centralising tendencies

It is undoubtedly the case, as the commission argues, that private legislation provided a vehicle for innovation in Victorian local government in the face of the social, economic and physical impacts of the industrial revolution. 

The genesis of public health lies in local legislation as does the creation of public utilities to provide gas, electricity and public transport. It was the ability of local corporations to promote private legislation that fuelled Joseph Chamberlain’s ambition to turn Birmingham Corporation into “a real local parliament”. Private acts were also used by enterprising councils to evade the centralising tendencies of successive governments in the second half of the 19th century.

It is also the case, however, that by the inter-war period private legislation had become a feature of the tensions in central-local government relations rather than necessarily being a solution to them. The resources and ambition required to draft and promote private legislation reinforced a growing divide between “advanced” or “progressive” councils on the one hand and “backward” or “penny-pinching” councils on the other hand. This reinforced differences between the major cities and smaller towns and rural areas. The widespread use of private legislation also contributed to the ad hoc and complex structures and powers of Victorian local government.

Significantly these trends were reflected in the justification for increasing central government intervention in local politics. In the 19th century there was a shift in ministerial focus from corruption to efficiency and action to bring “backward” councils up to the standard of the “progressive”. The first half of the 20th century saw a financially driven move to rein in the most innovative councils and drive improvement in the poorly performing ones. The dispute between Churchill and Chamberlain over the Bristol bank bill is an example of this.

Clause acts and adoptive acts

Despite these warning notes from history, the ambition of the Brown commission to enable local leaders to have access to a streamlined process to initiate local legislation should be welcomed. Many of the problems that emerged when private legislation was a common feature of local government could be overcome if it was explicitly seen as a way of testing new legislative powers prior to wider adoption – genuine pioneering.

Two other legislative devices deployed in the Victorian period could help to secure this approach if they were refreshed alongside a revival of local legislation. The first device is a clauses act, the prime example being the Town Improvement Clauses Act 1847. It brought together the provisions most commonly inserted in and effectively deployed through local legislation. Clauses acts, each of which would relate to a particular service area or initiative, would both streamline the legislative process and avoid unhelpful adhockery.

The second device, which takes this a step further, is the adoptive act. This is a piece of legislation which has been through the parliamentary process but which comes into effect only when it is adopted by individual local authorities. Acts of this type could make powers that have been successfully adopted by one authority available to be adopted by others without requiring local drafting or taking up parliamentary time.

Earned autonomy?

One other issue which requires attention is whether there should be a link between an ability to initiate local legislation and a council’s perceived performance. A sustained thread running through central-local government relations since the 1830s is the view that that councils should not benefit from new powers or responsibilities until they have met certain conditions or achieved a certain standard.

Joseph Chamberlain, who made extensive use of private legislation in Birmingham, took a different view. In 1877 he argued that “whatever the defects” of a council “I defy you to make a better one for the place except by gradually increasing its functions and responsibilities and so raising its tone.” No earned autonomy for Chamberlain!

If the increased use of local legislation is to help achieve the ambition set out by Brown and his commissioners, it is essential that streamlined access to local legislation is available to help struggling councils to improve rather than as a reward for having done so.

This article first appeared in the Local Government Chronicle on 13th December 2022.

Phil Swann is researching a PhD on central-local government relations at INLOGOV

Integrated Care Boards – a new frontline in localism?

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Jason Lowther

As the government once again kicks down the road decisions on vital reforms and funding for social care, local areas are establishing the Integrated Care Boards which will lead the new Integrated Care Systems (ICS), bringing together the NHS, local government and partners to plan and deliver integrated services to improve the health of the local population.  Building on the progress made since many public health responsibilities transferred back to local government in 2013, this is a great opportunity to address the determinants of health and issues around health inequality.  Might ICSs at last lead to an effective local voice in our over-centralised, top-down healthcare system?

Each ICS is supposed to plan at three levels: the neighbourhood (an area of around 40,000 people), the ‘place’ (often a LA area), and the (ICS) system (covering around 2 million people).  Working at the neighbourhood level is likely to be somewhat informal, often using a social prescribing approach and developing multi-disciplinary teams including third sector partners.  The approach to ‘place’ looks set to vary between areas, with some ICSs devolving significant responsibility (and funding) whilst others centralise these at ‘system’ level.  Meanwhile at ‘ICS system’ level, Integrated Care Partnerships (joint LA and health committees) will develop an Integrated Care Strategy to meet the assessed health and social care needs of their population identified in the Joint Strategic Needs Assessments and Wellbeing Strategies prepared by local Health and Wellbeing Boards.

Beyond the formal planning process, the success of local ICSs will partly depend on the quality of local collaborative (managerial and political) leadership – across statutory partners and with the third sector.  It will be a tough job to balance the priorities of the national health service and issues of local places, but many local authorities will be able to offer helpful experience , for example from moves to more networked governance approaches.

The National Audit Office recognises the potential but appears dubious on current prospects.  Last month it published a review, Introducing Integrated Care Systems: joining up local services to improve health outcomes, finding:

“NHSE has a detailed regime to monitor performance against core NHS objectives but … it is less clear who will monitor the overall performance of local systems, and particularly how well partners are working together and what difference this new model makes…“

The report notes that, whilst government is asking ICSs to set out local priorities and make progress against them, there is no protected funding and few mechanisms to ensure this happens.  This leads, as the NAO politely puts it, to “a risk that national priorities, and the rigorous oversight mechanisms in place to ensure they are delivered, crowd out attempts at progress on local issues”.  The report also identifies five “high risk” elements of effective integration: clarity of objectives, resourcing, governance and accountability (such as how ICSs will function alongside existing local government Health and Wellbeing Boards and how accountability differences between NHS and local authority bodies will be resolved), and the capacity to balance priorities other than national NHS targets. These urgently need to be addressed if ICSs are to begin to meet their potential.

At one of Inlogov’s “Brown Bag Lunch” discussions earlier this month we agreed on the importance of issues around how ICSs develop, particularly in terms of developing effective system leadership and planning, collaborating with community organisations, and links to wider devolution processes. I’d be interested to hear about experiences in local areas as these develop. 

Jason Lowther is the Director of INLOGOV. His research focuses on public service reform and the use of “evidence” by public agencies.  Previously he worked with West Midlands Combined Authority, led Birmingham City Council’s corporate strategy function, worked for the Audit Commission as national value for money lead, for HSBC in credit and risk management, and for the Metropolitan Police as an internal management consultant. He tweets as @jasonlowther

Picture credit: National Audit Office

Is Government Giving Value For Money?

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Jason Lowther

When money is short, how we spend it becomes even more important. As central government reheats its arguments for austerity following the chaos of the last few weeks, I’ve been reflecting on the contents of the 2021 budget (just a year ago).  The 2021 budget set out not just spending plans, but also a souped up approach to measuring outcomes and cost-effectiveness of government spending. How are these playing out, and will they survive the No 10 merry-go-round?

Rishi Sunak, then eight months into the job as Chancellor, noted that government borrowing was relatively high after the pandemic, warned of the public finances’ exposure to rises in interest rates, and outlined how spending was being linked to the delivery of outcomes alongside across the board ‘efficiency savings’:

The fiscal impact of a one percentage point rise in interest rates in the next year would be six times greater than it was just before the financial crisis, and almost twice what it was before the pandemic…

Decisions have been based on how spending will contribute to the delivery of each department’s priority outcomes, underpinned by high-quality evidence. The government has also taken further action to drive out inefficiency; SR21 confirms savings of 5% against day-to-day central departmental budgets in 2024-25. (page 2)

The “priority outcomes” are the latest in a long line of attempts to prod government spending into delivering effectively on political priorities, rather than blindly increasing/decreasing by x % compared to last year.  A 2019 report from the Institute for Government helpfully outlines many of these earlier initiatives (summary from the House of Commons Library) including:

  • “Scrutiny programmes” and the Financial Management Initiative (FMI), introduced under Thatcher.
  • The Cabinet Office and Treasury set up the Financial Management Unit (FMU) in 1982 to help with creating plans under the FMI.
  • The “Next Steps” report, published in 1988, which recommended the establishment of executive agencies to carry out the executive functions of government.
  • Tony Blair’s administration developed a greater focus on performance targets and Public Service Agreements (PSAs) which put these targets on a formal basis.
  • In 2001, Blair’s government also set up the Prime Minister’s Delivery Unit (PMDU), which was intended to coordinate PSAs and bring them under more central control.
  • Under the coalition government in 2010-15, PSAs were abolished and replaced with Departmental Business Plans (DBPs). These shifted the focus from targets to actions – in other words, they listed what each department would do and by when, rather than what they sought to achieve.
  • Under the Conservative government in 2016, DBPs were renamed to Single Departmental Plans (SDPs), which were themselves renamed to Outcome Delivery Plans (ODPs) in 2021. According to the NAO, SDPs (and by extension, ODPs) are supposed to be “comprehensive, costed business plans”.

As well as having to write down what outcomes they want to achieve, and how they will know whether that is happening, under the SDP system departments were also required “to assess progress in delivering their priority outcomes [and] … share regular performance reports with HM Treasury and the Cabinet Office”. 

In the 2021 spending review, the departmental outcomes were spruced up to reflect the (now last-but-one) PM’s five priorities of levelling up; net zero; education, jobs and skills; recovering the NHS; and reducing the volume and harm of crime.  

This blog’s audience may be interested in “Where does local government fit in this compendium of key priorities?”  The answer is a little depressing: on the last line of the last page (page 30 of 33), just before the devolved government departments. The relevant outcome is inspiring enough: “A sustainable and resilient local government sector that delivers priority services and helps build more empowered and integrated communities”, albeit with the reassuringly non-SMART measure that “the department will provide narrative reporting on progress for this outcome”.  Of course I exaggerate, because local government has critical inputs to very many of the earlier outcomes too, but it’s hard not to conclude that local services and communities were not yet at the top of the ministerial attention list.

Will the “priority outcomes” survive the whirlwind of ministerial movements and unforced economic missteps?  After the last seven weeks, I’m not going to make predictions – but we should know in the next month, and alongside the financial figures they could be our best hint yet on where a Sunak government is heading.

Picture credit: https://www.youtube.com/watch?v=Du_6mRV8Hm8

Jason Lowther is the Director of INLOGOV. His research focuses on public service reform and the use of “evidence” by public agencies.  Previously he worked with West Midlands Combined Authority, led Birmingham City Council’s corporate strategy function, worked for the Audit Commission as national value for money lead, for HSBC in credit and risk management, and for the Metropolitan Police as an internal management consultant. He tweets as @jasonlowther

Black History Month

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Picture source: https://www.evertonfreeschool.com/2020/10/06/black-history-month-2/

Cllr Ketan Sheth

Black History Month creates a moment when we can step back and reflect together, as well as individually, on  the immense contribution of Black, Asian and minority ethnic communities whose rich history, culture, and experiences, have shaped Brent and beyond.

The NW London Joint Health Scrutiny Committee comprises 8 NW London boroughs. As Chair, I know we simply could not function without the dedication, the skills, and above all, the compassion that thousands of people from our diverse communities contribute to the NHS, day in and day out.

The difference this makes to all our lives, is immeasurable. Black History Month affords us an opportunity to acknowledge and thank them for the important work they do: their continuing contribution to the care, the culture, the shaping, and well-being of Brent.

The colour of someone’s skin should not determine how they are perceived, considered, and treated – positively or negatively – but the impact of the pandemic has highlighted many disturbing features of inequality in our communities. Many of these problems are not new. They have existed for far too long.

Black, Asian and minority ethnic communities are more likely to be affected by life-changing diseases like diabetes, prostate cancer, and sickle cell than people from other backgrounds.  Living  in less-affluent areas, they are more  greatly affected by poor housing as well as poor air quality from the busy urban roads that run through their neighbourhoods. There is a big gap in life expectancy between richer and poorer areas irrespective of race, but these communities are disproportionately affected. 

To tackle these inequalities, the North West London Integrated Care System is launching a  joint initiative between the local NHS and NW London boroughs, which will seek to build real understanding of what matters to our residents, how we can work with them to remove barriers to health equality to deliver healthier neighbourhoods and better outcomes. 

This initiative is the first tangible benefit I have seen emerge from the  new Integrated Care System, which has health services and local authorities coming together to address many of the challenges that impact our well-being. That is, health and care services, employment, education, housing, and the environment we live in.

We might perhaps reflect for a moment on the work of the great poet, James Berry OBE, who never avoided the difficult issues of injustice in history, or in the present, but always sought for mutual understanding. His poem, “Benediction,” stresses the need for us truly to hear one another, and truly to see, and through so doing, to understand. He said:

Thanks to the ear that someone may hear

Thanks to seeing

that someone may see

Thanks to feeling

that someone may feel

Thanks to touch

that one may be touched…

Black History Month is a reminder to us to truly hear and see one another, to celebrate our heroes and tell the stories that, for so long, have been hidden or forgotten. It is also a reminder that the evils of the past have resonance today, reflected in the impact of poverty and institutional racism that many in our communities experience as part of their daily lives. Ultimately, it is an opportunity to continue to learn, understand and come together to pull down these barriers and build healthier and fairer neighbourhoods.

Cllr Ketan Sheth is Chair of Brent Council’s Community and Wellbeing Scrutiny Committee

The role of scrutiny in navigating our new health and care economy

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Picture credit: https://www.gponline.com/deadline-extended-gp-access-cover-england-brought-forward/article/1456385

Cllr Ketan Sheth

Mortality rates during the pandemic laid bare the health inequalities that exist across the country. Behind these figures lie human stories and grieving families that should remind us of the urgency and importance of understanding and addressing these inequalities.

In Brent, an ethnically diverse North West London borough, we recently set out to do just that.

Systems thinking

We know that Brent residents, who are from ethnic minority communities, disabled, or who are in poverty, experience significant health inequalities; but what does that look like in practice? How are our healthcare systems contributing to and/or compounding inequality? And what can be done to resolve this challenge?

Usually, GPs are the first point of call when someone is not feeling quite right. They ought to help everyone to access timely and safe healthcare. Therefore, reviewing access to GP services is critical and we decided to focus a dedicated scrutiny task group for eight months to report.

By giving ourselves time to understand this complex area in detail, we developed a deep comprehension of the landscape we were going to scrutinise. Patient voices are at the heart of our work, and we worked closely with Brent Healthwatch to ensure those from communities that have been under-represented in these conversations in the past, as well as those experiencing the worst health outcomes, were able to articulate and share their experiences.

Also, the task group held a number of evidence sessions over the course of six months, which were attended by stakeholders across Brent’s health economy. This included council officers, local commissioners and service providers.

All of this enabled the team to make a number of practical recommendations to  Brent Council and NHS partners.

Our work focused on three pivotal areas: Demand, Access and Barriers

With the dynamics of our healthcare and well-being landscape changing locally as well as nationally, it is more vital than ever to ensure all our residents have equality of access and consumption of healthcare services.

We found repeatedly that some groups of patients experience significant, and unnecessary, barriers, specifically:

• Patients of low-income

• Patients with a disability

• Older patients

• Patients whose first language is not English

• Children and young people

• Refugees and asylum seekers

• Patients who cannot access digital technology

Knowing this, GP services must seek to reduce and resolve the barriers experienced by patients, with a focus on deprivation, ethnicity, disability, and other protected characteristics as described in the Equalities Act 2010, if we are to execute our duties under the Act.

We recognise that rising demand, changing patient expectations and workforce retention issues continue to place pressures on primary care. Therefore, it is essential that the NHS continues to plan for this and uses the expertise of healthcare professionals across the system.

The digital transformation to healthcare, brought about by the pandemic, although helpful to some, introduced additional barriers for other people and communities.

In acknowledging the varying levels of ease in which patients access GP service, we strongly believe an access and treatment standard ought to be developed. This will ensure that Brent residents experience consistent and high levels of service: whether their requests are routine or urgent, focused on physical or mental wellness; or made via the telephone, online or in-person.

Our work has been conducted in the spirit of cooperation and partnership, and particularly, we look forward to continuing our dialogue and work with our partners across Brent’s health economy to evolve our shared vision of GP access across Brent.

Cllr Ketan Sheth is Chair of Brent Council’s Community and Wellbeing Scrutiny Committee