Scrutiny

Forging an alliance with the NHS

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Cllr Ketan Sheth

If local councils and the NHS do not work together as trusted equal partners, our residents are the ones that lose out.

In Brent, our local communities were among those most affected by the first and second waves of the Covid-19 pandemic, with the local hospital, Northwick Park, making the national headlines having been caught in the eye of the storm, which acutely demonstrated the terrible impact of health inequalities on real lives.

We are, of course, particularly reliant on our NHS partners to provide emergency services, planned elective care, and a full and complex mix of outpatient and specialist services, including mental health and community services.

Likewise, NHS staff are reliant on local councils (and other local partners) playing their part in delivering a seamless patient pathway, that can go from a first GP visit right through to a tailored social care package.

Delivering high quality, equitable health services take detailed planning and a solid grasp on the needs of local communities.

In Brent, we have seen increasing levels of partnership working with the local NHS trust. Collaboration is made easier because London North West University Healthcare NHS Trust (LNWH) shows a refreshingly genuine commitment to gaining a deep appreciation of the views, concerns, and perspectives of our local populations. This is reflected in the development of the trust’s new five-year strategy. 

In addition to undertaking vast analysis of public health, demographic and other data relating to our communities, LNWH sought engagement right from the start. The trust co-created a strategy with the help of almost 900 local community members and 40 representatives from local authority and partner organisations. Over 2,300 staff also contributed, many of who live locally and reflect the diverse population of our local communities and are frontline NHS staff who know all too well the importance of good partnership working.

I hosted one of the open forums for the trust where the local residents had an opportunity to say what they felt should be the trust’s priorities. Working in partnership with local communities and improving the quality of care came out as key themes.

This is not surprising. In Brent, our communities experience significant health inequalities when compared with regional and national levels. Local councils like Brent can only provide so much support to address these issues, so we must work with NHS partners to combat health inequalities right across our health and social care system. Indeed, we are now seeing an increased trust present at place-based and neighbourhood meetings.

One of the biggest challenges facing LNWH is the level of emergency activity. As a local council, we must work collaboratively to address systemic issues like this that the trust cannot resolve alone. Indeed, the emergency pathway is a key touchpoint for the most deprived people in Brent and partnership working presents us with a real opportunity to connect them earlier with more appropriate support in the community.

The trust’s discharge processes are perhaps the most reliant on partnership working — the NHS isn’t just its hospitals. It’s vital that we work collaboratively across organisations — the rest of the local NHS like GPs, district nursing, mental health and social care — to help the trust improve the flow of patients through its hospitals.

LNWH has called its new five-year strategy ‘Our Way Forward’. It sets out a welcome commitment to local authorities, communities, and people. We must take joint responsibility for Our Way Forward, because by working together we will forge a far better health outcomes for our residents than we can alone.

Cllr Ketan Sheth is Chair of North West London Join Health Scrutiny Committee

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

Transitional safeguarding – putting children first

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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?

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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)

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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.