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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