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

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

Transitional safeguarding – putting children first

Cllr Ketan Sheth

Picture credit: https://drugpolicy.org/issues/protecting-youth

Most of us can remember as teenagers those exciting moments of independence, of achieving the landmarks of adulthood; perhaps learning to drive; our first relationship; our first job. These landmarks all signify moments of increasing maturity, of independence, but each of these landmarks remind us that there is no one moment of independence. We don’t flip a switch to become a grown-up – one day a child, one day an adult. Maturity is a gradual process, a high wire that we walk where most of us benefit from a safety net of parents, family, friends. 

For our most vulnerable children and young people too, there isn’t a switch and sadly too often they don’t have the safety net they need. There is now much more emphasis on the transitional period so that services extend from aged 16 to around 25. There should not be abrupt changes to a service just because someone reaches the age of 18, with its attendant risk of falling between the gap where services don’t always join up!

In recent years, safeguarding children and adults has become increasingly complex, with risks such as sexual exploitation, gang and group offending and violent crime challenging the children’s and adults’ safeguarding workforce to identify opportunities for innovation. The notion of transitional safeguarding is an emerging one, not currently widely applied in policy or practice. Its implementation requires changes in policy and practice and across systems involving all agencies. 

However, some local authority areas, like Brent, are already innovating and creating opportunities for more flexible and bespoke support, and providing valuable experiences for young people at a key point in their lives. This makes sense in most circumstances, but keeping vulnerable young people safe as they transition from adolescence to adulthood challenges us all to remember that becoming an adult is a process of transition, of many moments. 

Transitional safeguarding is an emerging area of practice where we challenge ourselves in public service to make sure we keep that safety net in place; that we help keep safe and promote the well-being of our young people when they need it most, regardless of the artificial barriers of age, and including during those important times of transition to adulthood. 

Supporting young people’s safety and well-being during the transition to adulthood is not only morally and ethically important, but it is also important for the future health of society and future generations. Young people may experience a range of risks and harms which may require a distinct multi-agency safeguarding response, and safeguarding support should not end simply because a young person reaches the age of 18. Investing in support to address harm and its impacts at this life stage can help to reduce for the need for specialist and statutory intervention and criminal justice involvement later on in life.

In Brent, my scrutiny committee recognises the importance of taking this holistic, broad view for our Brent young people. We believe we are well placed to be at the vanguard of these developments, with promising pilot work, in collaboration with partner organisations, already completed to change and enhance services; and my scrutiny committee are recommending that Brent develops a council-wide approach to transitional safeguarding by working with those young people who need us most.

And most importantly, I think that everybody has a valuable contribution to make to the transitional safeguarding agenda to help improve our practice for the better outcomes of all our most vulnerable young people; and indeed, the service is there when they need to use it.

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

Getting under the skin of council budgets: what does good scrutiny look like?

Cllr Ketan Sheth

It’s a testing but all-too-familiar mix: funding cuts from central government, skyrocketing demand for local services, a growing population, tough choices and communities vulnerable as they recover from the social and economic shocks of the pandemic. As we approach budget setting, our situation in Brent – a NW London borough – mirrors the position of local authorities around the country.

​Against this challenging backdrop, I believe the role of effective Scrutiny is more important than ever, and so too is learning from one another.

This year, I co-chaired Brent Council’s Budget Scrutiny Task Group. It was our job to get under the skin of budget proposals, to grasp their real-world effects, to understand any mitigations, and to make recommendations where we felt the decisions of our Cabinet, and Full Council, could be strengthened.

To bring forward a balanced budget, this year we were called to scrutinise a package of savings totalling £2.7million, alongside Council Tax increases.

A deeper approach to scrutiny

Given the stark financial picture across the country, from the outset, we wanted to make sure that scrutiny was grounded in the complex reality of the difficult decisions that the Cabinet needed to take. We were determined that the scrutiny process must add value.

As a group, we worked with officers to develop a much broader approach than simply reviewing proposed savings. Instead of solely relying on the community consultation undertaken by the Cabinet, we went into detail on the impacts and sought out testimony from people on the ground. We felt we needed to get a deeper understanding of the experience of those who use Brent’s services and the complexity of their situations.

The idea was to test underlying assumptions made in the proposals, in order to give Cabinet and Full Council information and evidence to base their decisions on. We identified a number of areas to probe:

1. Impacts of Covid-19 on income from business rates, Council Tax and rents;

2. The impacts on health inequalities work when grant funding ends;

3. Implications of Covid-19 on the adult social care budget, especially mental health;

4. Pressures within the Dedicated School Grant; and

5. How the council’s £17m Covid-19 recovery package is being spent

The task group agreed a mix of less conventional scrutiny methods to build this holistic view, including focus groups and detailed evidence sessions with people on the ground. From local head teachers to voluntary and community sector partners, teams from our well-being  services, and Brent Hubs staff (Brent Hubs are spaces in the community bringing lots of services together under one roof to improve access for residents with more complex needs).

By taking this approach, we were able to assess the wider financial and service context, identify possible future budget pressures and the likely emerging needs of our communities.

It allowed us to make a number of nuanced, practical recommendations when reporting back. Most focused not on the savings themselves, but on how the Cabinet  might work differently to overcome and address some of those pressures. Helpfully, the group also identified areas where we felt the Council could effectively lobby for more support nationally and regionally. We’ve also put in place mechanisms for pulling insights from these testimonies as well as learnings from this deeper process through to future budget scrutiny cycles. Ultimately, we are all trying to deliver a better outcome for local people, and so I’m a big believer in the power of scrutiny to support good decision-making. I think that this is best realised by being a “critical friend”. The deeper, more contextual approach we took in Brent this year achieved just that, and I look forward to seeing these efforts bear fruit when the budget is taken to Full Council later this month.

Cllr Ketan Sheth is Brent Council’s Chair of Community and Wellbeing Scrutiny Committee and co-chaired its Budget Scrutiny Task Group

Monday Jan 17th 2022 – The Great Parliamentary Resistance (Part 1)

Chris Game

About the first sizable 2022-dated research-based publication I at least scanned was the alliteratively subtitled The Great Reset: Public Opinion, Populism, and the Pandemic by Cambridge University’s Centre for the Future of Democracy.  Based on massive international data sets, it finds that (summarising outrageously), while the pandemic has generally reversed the rise of populist leaders, parties and attitudes, the cost has been “a disturbing erosion of support for core democratic beliefs and principles, including less liberal attitudes with respect to basic civil rights and liberties, and weaker preference for democratic government.”

The UK Government can obviously provide numerous illustrations – from its treatment of refugees and asylum seekers to a Justice Secretary who wants to rewrite the Human Rights Act minus its “wokery”.

But then, literally following the weekend of my coming across The Great Reset, we had the extraordinary, in parts even historic, Monday evening of the Great Parliamentary Resistance.

Both Houses were involved, and two separate Government Bills, both as controversial as they are important, both the subject of consequential, even history-making action simultaneously throughout the evening – and virtually all of at least interest, where not of direct relevance, to an Institute of Local Government Studies.

This Government, even in its legislative behaviour, is greedy, disorganised and unscrupulous, and on that Monday 17th it was all on display – the problem being that, with the more complicated (House of Lords) action being summarily and potentially misleadingly reported, doing justice to the historic legislative events seemed a bit too much for a single blog.  What’s more, I didn’t come across a single stealable visual aid.

So, I took a decision: two separate but linked blogs. The second – because it makes better chronological sense – will cover the hugely controversial Elections Bill, that seeks to ‘Reset’ some of those core democratic beliefs and principles referred to above: among other things, introducing mandatory voter ID at polling stations, undermining the independence of the Electoral Commission, and changing the electoral system for Mayors and Police & Crime Commissioners.

Its intentions to restrict voting are blatantly partisan; it has been rammed through Parliament, added to and amended, minimising legislative scrutiny; and on that Monday evening it received its Third Commons Reading on more or less straightforward partisan lines (https://www.bbc.co.uk/news/uk-politics-60037651), and thereby progresses to the Lords.

Both Jason Lowther and I have blogged previously about aspects of the Bill, and Part 2 of ‘The Great Parliamentary Resistance’ will shortly update them.

For the remainder of this Part 1, though, it’s across to the Lords and their truly historic Monday evening, when they savaged the Government’s ‘flagship’ Police, Crime, Sentencing and Courts Bill – and not once or twice but an apparently Parliamentary record 14 times! 

Even the Bill’s title suggests a huge legislative gallimaufry, and it is – a classic Priti Patel production, taking the whole of the second part of last year to progress through the Lords to last Monday’s Report stage. That time lapse proving, pleasingly piquantly, the key to some of the Government’s difficulties.

For Patel evidently thought it would be a clever wheeze to use the Lords’ extended deliberations as an opportunity to add all sorts of additional clauses to the Bill, covering some of the myriad things that had enraged her since March – like Insulate Britain’s M25 traffic obstructions last September and Extinction Rebellion protests around November’s UN Cop26 climate summit.

All of which meant that there were three distinct types of Government defeats – sorry, votes – taking place at this Lords Report Stage.  First, the ‘normal procedural’ ones, on parts of the Bill as received from the Commons last July, that the opposition parties in the Lords would like to see reconsidered by MPs and ideally amended or removed. This will kick off the process so whimsically known as ‘parliamentary ping pong’ between the two Houses.

Patel’s ‘late additions’, though, are another matter entirely: criminalising protests deemed too noisy and disruptive … and protesters ‘locking on’, either to each other or immovable objects … and interference with key national infrastructure … and obstructing major transport works … and allowing police to stop and search without giving reasons … and allowing courts to ban regular protesters from even attending protests …   The Lords defeated all of these and MPs can’t reinstate them, as they never voted them into the Bill in the first place, so they’re removed altogether – or at least until Patel repackages them into another Bill for the new parliamentary year starting in April.

Then there are the Lords’ own ‘late additions’ – reviewing the prevalence of ‘drink-spiking’ crime … and crime motivated by ‘misogyny’ … and removing police powers to determine what constitutes a ‘noisy’ assembly … and belatedly repealing the 1824 Vagrancy Act, thereby establishing that begging or sleeping rough should no longer, in this post-Napoleonic/Waterloo era, constitute criminal offences.

None of these were in the Bill when it left the Commons, but they are now – and if MPs don’t like them, they’ll have to vote them down.

What concerned me about the initial reports I read of the Great Lords Monday Night Rebellion was that most seemed, albeit understandably, excited by the record 14 Government defeats, to the point of failing to note the really rather significant differences in the categories and potential significance of the defeats – even some of those with a stake in some of that detail, like Police Professional or Green World.  

So, having recently received my copy of the Inlogov Associates Handbook and being slightly apprehensive that the Director might try to inveigle me into some actual lecturing, I thought I’d prepare the first new overhead I’ve attempted for, well, a few years now – summarising at least my understanding of the current state of play. Hope it helps!

 

 

 

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Chris Game is an INLOGOV Associate, and Visiting Professor at Kwansei Gakuin University, Osaka, Japan.  He is joint-author (with Professor David Wilson) of the successive editions of Local Government in the United Kingdom, and a regular columnist for The Birmingham Post.

Royal Consent – If only I’d known 40 years ago

Chris Game

Queen

Photo credit: West Midlands Police – Royal Diamond Jubilee Visit

The Queen, I learned recently from my Murdoch Sunday newspaper, is “keen to hit her stride again” and indeed is already “ramping up for a very busy summer”.  Unsettling image, a ramping-up 95-year-old.  More personally, though, justification for not feeling too bad about airing a long-term grievance – for, as I’ll explain, I reckon she owes me.

This royal debt dates back to my pre-INLOGOV days, when, as mentioned in a name-dropping blog only quite recently, part of my 1970s was spent endeavouring to interest visiting American students from California’s Stanford University in the similarities and contrasts between their presidential government system and our constitutional monarchy.

Seminar exchanges would go something like this. You Brits call yourselves a constitutional monarchy, so you must have a constitution?  Yep – a set of the most important rules regulating relations between the different parts of the government and the British people.

But not written down?  Of course they’re written down, but in various forms: parliamentary statutes, judge-made laws, works by constitutional ‘authorities’, and what have become accepted conventions.

They’re just not ‘codified’, or fossilised, in an almost unamendable 1787 capital-C Constitutional document like yours – which, incidentally, says almost nothing useful about the US electoral system, political parties, or modern-day powers of its Supreme Court.

Britain’s uncodified, small-c constitution has enabled us, I’d suggest, to assimilate potentially huge changes without agonising for decades about whether and how to amend a capital-C Constitution.

Proof? The 19th Century metamorphosis during Queen Victoria’s reign from a real, if limited, executive monarchy to a virtually ceremonial one or effectively a republic: a state run by the people’s elected parliamentary representatives, but without a directly elected head of state.

[Literally parenthetically, I might add here that I genuinely can’t now recall how much of this stuff I actually believed and how much was pedagogical convenience. I don’t feel I’ve ever wholly supported the UK having an all-encompassing, written capital-C Constitution, as advocated recently for instance by the Lib Dems in their 2019 Manifesto (p.79), and for the Constitution Unit by QMU’s Prof. Douglas-Scott – not least because I’ve found it hard seriously to imagine it actually happening.

[I was, though, and think still am, in favour of something resembling what – in evidence to the (subsequently Conservative-abolished) Commons Select Committee on Political and Constitutional Reform – Profs George Jones and John Stewart termed a more limited “constitutional settlement governing relationships between central and local government”, giving the latter constitutional recognition as an elected institution].

Back, anyway, to the role, and powers, of that ‘virtually ceremonial’ constitutional monarchy, with which, like most Americans, Stanford students had an almost insatiable fascination.

They knew before arriving that their Berkshire Thameside campus, Cliveden House, had been the country home of the 18th Century Prince of Wales, and staged the first performance of the even then embarrassingly patriotic anthem, ‘Rule, Britannia!’.

They quickly learnt about the Queen owning all the river’s ‘unmarked mute’ swans, having her own Swan Warden, driving without a licence and number plate, and – from glossy US magazines in those pre-Google days – dozens more “incredible powers you didn’t know she has”.

So much truer than I realised!  My role then, however, involved emphasising how most of these incredible powers – even, I guessed, recruiting Swan Wardens – were symbolic, and in practice exercised by others.

Some were easy. Supreme Governor of the Church of England: Henry VIII was certainly hands-on, but nowadays it’s a combo of the PM and Church leaders. Head of the Armed Services: Ministers and the Defence Ministry do policy, armed forces most of the fighting.

Opening and closing Parliamentary sessions, the Queen’s Speech, the Government’s legislative programme, creating members of the Lords – again, all determined by Ministers. Appointing the PM – yes, but following election by their party.

My biggest explanatory problem was Royal Assent and Consent.  Royal Assent is straightforward: the Sovereign’s purely formal agreement that a Bill, passed by both Houses of Parliament, be enacted as law.  Last refused, as all textbooks dutifully record, in 1708.

But check those same textbooks for Royal, or even Queen’s, CONsent, and you’ll be lucky to find much more than the 5-line paragraph graciously offered under ‘The Queen and Parliament’ on the www.royal.uk website: “It is a long-established convention that The Queen is asked by Parliament to provide consent (which is different to assent) for the debating of bills which would affect the prerogative or interests of the Crown”.

Long established maybe, but minimally publicised, discussed and understood. And there’s more. Should the Royals (Charles has a Prince’s Consent too) even suspect that something in any draft Bill might adversely affect their extensive prerogative rights or ‘personal interests’, they can potentially stop it even getting debated, never mind becoming law, and usually without leaving even a written record.

That’s why I reckon they owe me personally – as well as, obviously, all UK citizens (sorry, I forgot: ‘subjects’). Because, while I was wittering to Stanford students about Swan Wardens, none of this seriously important stuff was public knowledge, in the sense of being debated, questioned, researched, quantified, or featuring in even ‘British Constitution’ textbooks.

Instead, there was/is effectively – in both senses – an Establishment connivance, between the leaderships of successive, supposedly democratically accountable Governments and the Royals, to keep all significant details of Royal Consent from us mere voters, taxpayers and university lecturers.

Only quite recently has even its scale become public knowledge, thanks particularly to The Guardian newspaper’s research moles. While I might have guessed at there being maybe two or three Royal Consents a year, it’s actually some ten times that.

The Guardian excavators have compiled a wondrous database of 1,062 parliamentary Bills (and rising) subjected since 1952 to the Queen’s or Prince’s Consent – or ‘royal vetting’, as they put it – from that year’s Clifton Suspension Bridge Bill (no idea why) to the 2020 EU Future Relationship Bill (I’d guess Sandringham and Windsor farming subsidies). All of which the Royals had first go at influencing in their own interests.

One serious purpose of this blog is to draw even some minimal additional attention to this fantastic research base and potential teaching aid – albeit decades too late for me personally.  In 1975, though, I know exactly what I’d have done: given groups of five students a year’s worth, say 25, and asked them to research what in each case they reckoned the Royal Consent hoped to gain.

[The original version of this blog was written for the Birmingham Post, July 1st, 2021, under the title ‘Secrets of Royal Consent that you’ll never hear of’]

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Chris Game is an INLOGOV Associate, and Visiting Professor at Kwansei Gakuin University, Osaka, Japan.  He is joint-author (with Professor David Wilson) of the successive editions of Local Government in the United Kingdom, and a regular columnist for The Birmingham Post.

Meeting like this…

Bryony Rudkin

The fieldwork for my PhD has consisted in part in watching and transcribing webcasts of council meetings. This was in the ‘before times’. Councillors like me up and down the country would put on their glad rags once a week or so, tip up at town halls up and do their thing.

Some of them would be filmed doing so and webcasts of meetings put up on council websites. Some recordings would be professionally produced using external platforms with nice little extras such as the relevant papers attached and easily referenced timings making it easy to watch the part of the meeting you were interested without having to wade through matters arising from the last one. Some of them were a little more homespun, filmed on phones and iPads, as one colleague put it, “local government styled by the The Blair Witch Project”.

Audiences for these would vary. Anecdotally, I was told officers would watch meetings in their respective councils to follow how their policy ideas were translated and received by councillors. Planning Committee meetings would get more hits from residents who were unable to attend in person but nevertheless wanted to know about their neighbour’s home extensions. One Chief Executive told me her mum watched and sent notes back on how her hair looked. And then there was me, collecting data with which to test my research questions.

All well and good. Then came the pandemic and lockdown and everyone went online. Whether it’s Zoom or Teams (other providers are available…) everyone from toddlers to great grannies logged on it seems. Quizzes were ubiquitous at the start and my family played some great drawing games (none of us will trouble Hockney). It’s not all been plain sailing though and we’ve all heard tales of Zooms gone wrong. Kids, dogs, nudity and those chat messages sent to all in error. I sat through one where someone, in response to a dull peroration on cycle paths, lifted their foot up and started to scratch it.

My rather niche research field has become a daily reality for most of us. I get regular messages along the lines of ‘you won’t want to miss this one….watch from 29 minutes in!”. I’ve been asked to comment on individual performance and style – “does my bookcase look big in this one?” – and I’ve taken part in virtual peer reviews and given feedback, online of course. I’ve been a participant myself of course and not just in council meetings. I’ve presented to an academic conference, chaired a meeting with a shadow minister interrupted by an ice-cream van outside her house and next month I’m monitoring elections in Bulgaria.

What has all this brought to my research? Well, put simply, meetings held online are a different matter to those held in person and publicly broadcast meetings something else again. Being at home, being alone in a room without colleagues to encourage, moderate or provoke can lead to unguarded moments. ‘Home truths’ are just that sometimes.

The organisation and direction of online meetings is a different process and the outcomes unpredictable. I recently watched two recent meetings in one authority, one calm, the other chaotic but the former was darker in tone and raised issues of bias and the chaos of the latter simply demonstrated a community at ease with itself and its challenges.

How we move on from here is a brave new world. Viewing figures are undoubtedly up and residents are getting more engaged. Hybrid meetings are now a reality. We all have new skills to learn and mute buttons to press. Watch this space….

Cllr. Bryony Rudkin is a PhD student at INLOGOV, Deputy Leader of Ipswich Borough Council and is a member of the UK delegation to the Congress of the Council of Europe. Bryony also works with councils around the country on behalf of the Local Government Association on sector-led improvement, carrying out peer reviews and delivering training and mentoring support.