Tuesday, November 6, 2012

Consultation and disclosure-Key to maintaining good government

Neil Zammett writes
I attended Redbridge Health Scrutiny on 22nd October, an extraordinary meeting just to deal with closure of A&E and Maternity at King George. It was a long and eventful meeting which raised a number of important issues;
· The right to consultation,
· The timely disclosure of documents
· The use of presentations instead of papers for meetings
Although the Committee did not identify these issues as a theme to me they all relate to Standards in Public Life which were laid out in detail by the Nolan committee. Just as a reminder Lord Nolan was charged by the Government with identifying the essential aspects of standards which were perceived at the time to have been “slipping”.
Two of the areas he identified were openness and transparency and I believe that the three issues which the Scrutiny Committee identified fall fairly and squarely into these categories.
The right to consultation
Letting people know what is going on is a prerequisite of good standards. It is at the heart of openness and good governance. The present Government has reaffirmed its commitment to local people having a say partly through the localism bill and also the emphasis it has placed on local decision making in its reorganisation of the NHS.
But for Health Scrutiny committees there is an additional safeguard because since 1974 the right of consultation is backed up by a statutory obligation. This means that if action is taken to close, change the use of or “substantially vary” local services without consultation this act is unlawful or “ultra vires” to use the technical term.
There are two exceptions; where urgent safety issues prevail and where a pilot scheme is involved.
If a senior NHS manager were to knowingly act “ultra vires” it would raise serious issues about their judgement and the governance of their organisation.
On 22nd the Redbridge Scrutiny committee voted, (after some considerable wrangling with the Chair, with only one member against) to seek consultation on the changes to the plans to close Maternity Services at King George. This was based on the inclusion of the Homerton Hospital in the plans and the continued presence of A&E at King George.
But there are other closures taking place which the committee has not been informed of; St George’s in Hornchurch is one and closure will have an impact on King George. Foxglove ward was closed based on more intensive use of St George’s now this is closed as well.
Safety was an issue at St George’s because the antiquated heating system could break down, but this does not remove the obligation to consult unless the situation is urgent and to my knowledge it was identified as an issue some years ago.
We also need to know what changes at King George have resulted from the closure of St George’s; have wards such as Foxglove been re-opened to accommodate the patients displaced from St George’s?
The timely disclosure of documents
After numerous requests the Maternity Workforce Strategy for East London was sent at the eleventh hour to the Committee. Dated May 2011 it has never been published or subject to consultation even though workforce issues were central to the case for closing the maternity unit at King George.
What this reveals is the shocking fact that we need to double the number of doctors in five years and increase the number of midwives by 40%. It also shows that some of the hospitals which will benefit from the closure, like the Homerton actually have lower staffing levels than Queen’s and King George and that Whipps will have to double the number of midwives because it has such a low starting point.
Members also wanted to see the new outline business case for A&E at Queen’s because this is key to understanding the timescale for potential closure at King George and also reasons for the delay. This was declined because work on the plan is continuing.
But without key documents like this the Committee cannot do its work and the plan has been circulating within the NHS for months.
The use of presentations
Documents are the stock in trade of statutory organisations because they form such an important part of the way they work. They are integral to the legal basis for decision making and the governance of the organisation. Increasingly documents have been replaced at scrutiny meetings by presentations. This creates all sorts of problems because members do not have time to prepare questions and the spoken word is capable of different interpretations particularly if the meeting is not recorded in some way.
Effectively, presentations undermine the processes of good governance if they are used in place of written papers. Of course used in a supplementary way they can be very helpful but they are now becoming the norm not just in Redbridge but at the Joint Health Overview and Scrutiny meeting which covers the four outer London Boroughs.
Bullet points are no substitute for properly argued papers which can be evaluated and challenged.
The impact on scrutiny and governance
The combined impact of these three issues is to undermine the work of scrutiny and to prevent elected members discharging their constitutional responsibilities. It also runs totally counter to the principles of openness and transparency established by the Nolan Committee and represents bad government.
We should remember that these principles and the statutory right to consultation are there to protect the public and maintain standards in public life.
The vote by the Redbridge Scrutiny Committee to request consultation the new Maternity plan represents a welcome step towards recognising this.

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