Local Government and Public Involvement in Health Bill

As a member of one of the early standards committees, I welcomed its efforts to ensure that complaints were dealt with by local councillors and independent chairmen, rather than being second-guessed by a national board. Why is public satisfaction so low? One question that any resident would want to ask is, ““Why is my council tax rising? Who is responsible for that—who holds the purse strings?”” As Members have suggested, the whole issue of local government finance is missing from the Bill. That is a big omission, because it is in terms of that that people might feel a change in their level of satisfaction. They want to ensure that their council is much more responsible—that it is responsible for the taxation raised, and that that links in with representation and expenditure. I await the Lyons review with bated breath, but we must not delude ourselves about the importance of matters such as shifting the structures and seeking to improve consultation. The crux is whether local councils have proper autonomy. Let me turn to another significant part of the Bill. An issue for the public is whether they have a voice—whether they, or their representatives, are involved in decision-making. Is there a genuine devolution of power? The Government answer that by addressing structural change, but that takes them in the wrong direction. Their structural change involves looking at the option of giving more power to executive leaders. I have not had letters in my mailbag or people banging on my door demanding that more power be given to the council leader. People do not say that they want that. What they want—and what we want when we suggest that there should be more councillors, and that perhaps they might be younger and more able—is more power and accountability for councils and individual councillors. That is why it is profoundly disappointing that having a committee system is one of the options among the various structural models. When I was elected as a councillor in 1994, I was one of the youngest councillors in Enfield. It took a while for me to understand what was going on in the council, but I appreciated the signposts of the committee system. I knew where to go to get information and who to ask questions of. My party was not in control of the council at the time, but, as an opposition councillor, I appreciated having the opportunity to ask questions not only of councillors, but of council officers. We now have a system of cabinet government, and I was a cabinet member. I appreciated the level of involvement that I had with council officers and having some kind of streamlined decision making. However, the scrutiny of my role diminished, as did the amount of information that went not only to councillors but to the public. Also, newly elected councillors, in particular, do not know where to go. They are put on a scrutiny committee and it takes them a while to get to grips with the labyrinthine ways of how to hold an executive with increasing power to account. Other elements of the committee system that were of benefit were the degree of consensus and the cross-party working that could be achieved on a committee, for the good of a community. That now seems to be decreasing. I urge—as I will do again in Committee—that we look into at least giving local communities the option of having such committees, even though in my experience they are not perfect. Another issue to do with structure involves the standards committee. I welcome the recognition in the Bill that things have become centralised, that we need to devolve decision making, and that the conduct regime needs to be determined locally by local councillors working with independent members. I was an inaugural member of the standards committee in Enfield. The independent chairman and councillors on both sides of the party divide worked well and diligently. However, the committee became concerned that the standards board was increasingly taking powers and control away from it. Also of profound concern throughout the country is the increased detail and the increasingly bureaucratic nature of the code of conduct, and the fact that it lacks basic common sense. Therefore, the suggestion that there might be a clearer, simpler and more consistent and sensible code of conduct is to be welcomed. However, we will need to see how that works in practice. I particularly welcome the suggestion that there will be a reduction in the burden of best value and inspection. It is about time that that happened, and my party has campaigned vigorously for it, not least during election campaigns. It is also welcome that the Audit Commission might have a gatekeeper role in terms of inspection, instead of its seeking to perpetuate the inspection regime, which is a circus in many respects. The catchphrase ““community call for action”” sounds good and engaging, but will it involve the public? We must not ignore the fact that the public are engaged in the debate. I have held a number of public meetings about the north circular road—about the continued blight caused by that congested road that goes through my constituency. There was also a recent public meeting against the closure of Southgate police station. I can think of another one that intended to stop back-land development at New River crescent involving a number of houses along our river path. There was also a recent campaign about the proliferation of mobile telephone masts. All such local issues have caught the imagination and concern of many of the public, who are engaged. However, the public have a concern that the Bill does not address: they feel powerless to make changes in respect of such issues—issues that are of profound concern on their doorstep, and affect their lives. In the context of the north circular road, they see Transport for London as unaccountable to them—it is unelected—and that other legislation is not providing more accountability. They see Transport for London setting targets and taking action that they have no real control over. Communities see the Metropolitan Police Commissioner setting central targets for what are termed community assets, but they have no involvement in the decision as to whether they can keep their local police station. The Government set targets and guidelines for the density of back-land housing development; again, that is a case of second-guessing the local community. Similarly, the guidance on mobile phone masts makes little provision for consulting or involving local people. Those are the issues that my constituents are banging on the door about and feel powerless to address, not the structural change that the Government are trying to make, or the mechanism of the ““community call for action””. They are concerned that this is more than a structural change—that it is a substantive change not in the relationship within local government, but between central and local government. That concern is not being addressed; the Bill is silent on it. On local area agreements, the Bill refers to local targets, but the hand of central Government remains heavy. Why should the Secretary of State be able to approve local targets? Local councils and their partners should be free to determine their own targets through their own measures, instead of the Secretary of State seeking to second-guess them. To what extent will the community call for action process involve young people? Will they really be able to call on councils to act? Where is the reference in the Bill to young people’s proper engagement in that process? They are concerned about their communities, but will they really be able to facilitate a call for action? As I said in an intervention, crime and disorder is excluded from the community call for action process because it is dealt with in the Police and Justice Act 2006. However, what action should communities who are concerned about alcohol-related issues take, for example? Will such issues be dealt with properly? It is clear that they are not being dealt with properly now through the crime and disorder reduction partnerships. Will this bureaucratic model exclude such issues because they fall under the category of crime and disorder, and will that affect proper community engagement? I want to finish on the subject of patient and public involvement forums and LINKs. Constituents in my own forum have expressed grave concern about LINKs. They say that although the Government describe LINKs as expert panels, they are not taken seriously by local NHS organisations and carry little weight. My local forum has produced 18 reports, which have had a big impact and are well respected. In the last year, it has produced reports on the anticoagulation clinic, wards, catering services, the accident and emergency department and patients’ telephone services, and there are reports to come on blood testing and stroke facilities, maternity and obstetric services, and pharmacy and cancer services—I could go on. That is a vigorous and hard-working forum that feels that the proposed LINKs will not address these issues properly. It tells me that spot inspections of cleanliness and patient management are often far more effective than planned inspections by organisations such as the Healthcare Commission. I am concerned that the existing proper statutory duty to inspect will no longer exist, and that, as has been said, there will simply be a duty to observe, which comes with preconditions and caveats. I finish by referring to part 11 and the duty to consult, which is to be changed. Will a duty to consult only on significant changes really deal with issues in my constituency such as the local baby clinic and developmental checks, which have been removed without proper consultation? The duty to consult has not been properly upheld. I would welcome the measure if it would firm up the process, but the concern is that it will not. The dead hand of Government is clear in this regard. The question of what is significant is determined by the Secretary of State. The White Paper was called ““Our health, our care, our say””, and in Committee I will try to ensure that that phrase is not just words, but leads to action.