During Question Time in the House of Lords this afternoon I intervened to try and get a straight answer from Earl Howe, the Parliamentary Under Secretary for Health, as to how many Accident and Emergency Departments will close in London hospitals over the next four years. I also wanted to know who would take the strategic decisions for London as a whole and how they were accountable for those decisions.
Needless to say, I didn’t get a proper answer.
This was my exchange with the Minister:
My colleague Baroness Janet Whittaker tried again a minute later:
So the Minister acknowledged that there would be a series of closures of A&E Departments in London, but couldn’t say how many there would be because he didn’t have the “pan-London figures” in front of him. And, as all the decisions would be “subject to local determination” presumably as a result of the accumulated, but separate, individual commissioning decisions by local Clinical Commissioning Groups (whose less than satisfactory governance was debated last week), by implication there will be nobody who will take a strategic pan-London view of the level and distribution of Accident and Emergency Services in the capital.
Doesn’t inspire confidence……
Lord Blair of Boughton (the artiste previously known as Sir Ian Blair) has made a particularly silly suggestion. Interviewed on Sky News, he has suggested that people should boycott the elections on 15th November for Police and Crime Commissioners:
“I’ve never said this before but I actually hope people don’t vote because that is the only way we are going to stop this.”
Like most other people, Ian Blair thinks the proposed system of elected Police and Crime Commissioners is flawed. There are no proper checks and balances in the governance arrangements, many of the police force areas make little sense as electoral districts, there is a risk of politicising aspects of operational policing that should not be politicised, and the changes are a waste of money at a time when frontline police budgets are being cut as never before.
However, the legislation rightly or wrongly was passed last year with a its flaws intact (despite the best endeavours of some of us in the House of Lords). The elections ARE going to take place in just over three weeks time (holding the elections in November when it is likely to be cold, wet and dark was an incomprehensible sop to the Liberal Democrats). And yes, the turnout will probably be low – maybe very low – but a boycott is simply going to mean an even lower turnout and an even greater risk that maverick candidates will be elected.
Police accountability matters. This may be the wrong system, but on 15th November forty-one Police and Crime Commissioners will be elected in every part of England and Wales with the exception of London (where we have the “benefit” of an elected Mayor in charge of the Metropolitan Police and where the Corporation of London retains its own medieval system of oversight of the City Police).
A boycott will achieve nothing. I am confident that before too long this new system will have to be changed – probably drastically. In the meantime, because police oversight is so important in any democracy, everyone will have to make the best of the flawed arrangements. And that means ENCOURAGING people to vote on 15th November.
My colleague Lord Philip Hunt reported on the Labour Lords Blog that the new governance arrangements for the new Clinical Commissioning Groups (CCGs) through which most local NHS money will be channelled are odd in the extreme, saying:
“A massive £60bn is to be entrusted to them despite very weak accountability and corporate governance structures supporting what are essentially a federation of GPs. Only two lay members will serve on the Board of each CCG so they will always be outnumbered by GPs who will have little or any accountability to the public. This is even more perverse given that the CCGs may make funding decisions which are advantageous to GPs.
Bizarrely, although the regulations we are debating in the Lords allow for a hospital doctor and a registered nurse to be appointed to the CCG Board, those employed by a local hospital are not. This is apparently because it would be a conflict of interest!”
Last night’s debate in the Lords on the Government regulations setting out how CCGs are to operate showed up the sheer absurdity of the arrangements and the normally-sensible Minister, Earl Howe, tied himself in knots trying to explain why certain categories of person were to be excluded from the Boards of CCGs and why it would NOT be a conflict of interest for GPs on the Boards to so arrange local services so that their practices benefitted.
I rather lost my temper when it was suggested by former Tory Health Minister, Baroness Cumberlege, that local councillors should in all cases be excluded from CCG Boards on the grounds that they would be incapable of making difficult decisions affecting their electorates (what does she think local councillors are having to do at the moment given the budget cuts that the Government has imposed on them?).
However, the debate also highlighted the absurdity of the Government’s proposals which would prevent someone being appointed to be a “lay member” of a CCG Board if they were employed by a local authority anywhere in the country; or – even more bizarrely – prevented someone who is a member (not even a governor) of a local NHS Trust, when in some areas every person who uses the local hospital is automatically enrolled as a member of the Trust!
You can read the full debate here and my rant was as follows:
“In this debate we are perhaps being asked to suspend our disbelief that the governance arrangements for the clinical commissioning groups make sense. We are being asked to suspend our belief on the question of whether pigs may fly. However, the extraordinary statement from the noble Baroness, Lady Cumberlege, that somehow locally elected councillors are incapable of making decisions which affect the livelihoods of the populations that elect them is disgraceful.
Baroness Cumberlege: My Lords, I object to that. I said that they have a role on health and well-being boards, which is where the strategy is set out, and that is where the NHS, local authorities, Healthwatch and other organisations come together.
Lord Harris of Haringey: I understand that. My point is that the noble Baroness does not seem to understand that today, all over the country, locally elected councillors are making decisions about closures because they are having to balance the reductions in budgets that this Government are forcing on them and on their local communities. They are making those decisions on behalf of the people whom they represent. Why is it being said that somehow they have a conflict of interest which means that they are incapable of making decisions along with colleagues about health matters?
There are issues of principle here and issues of sheer practicality. The issue of principle concerns conflict of interest. The noble Baroness, Lady Cumberlege, has talked about conflict of interest. Perhaps we will also hear about that from the noble Earl in a minute. However, the biggest conflict of interest will be the fact that the primary care practitioners are key elements of the boards of CCGs’ governing bodies. They are not being excluded; it is just everyone else who is being excluded. Let us be clear about who is being excluded. It is not simply elected members but any employee not just of the local authority in the CCG’s area but of any local authority in the country. Therefore, any person who, under paragraph (4) of Regulation 12, the CCG feels has knowledge about the area and who does not have the misfortune of being an elected councillor but does have the misfortune of being a part-time employee of a neighbouring local authority is exempt.
When the Minister replies, I should like him to explain to us why every single employee of every single local authority in the country is being excluded from participation in CCGs. While he is about it and we are talking about conflicts of interest, we have already heard the point made by my noble friend Lord Hunt of Kings Heath that any person who has been public-spirited enough to decide to become-and frankly it is a fairly meaningless undertaking-a member of a local foundation trust or a local NHS trust is also excluded from membership of a CCG. Again, what is the point of that? It is being said that any person who is public-spirited enough already to have had some engagement with the local NHS is not allowed to sit on the board of the CCG.
This is frankly fatuous. You have ended up with a situation in which you have enshrined one set of conflicts of interest and excluded from the membership of the CCG all sorts of other people who could make a valuable and useful contribution. I am afraid that for the first time in our considerations I agree with 99% of what the noble Baroness, Lady Jolly, said. The 1% with which I disagreed was that we should allow this instrument to go through and review it again in two years’ time. It is so flawed and riddled with poorly thought-out considerations of what would work at local level, and so dismissive of the best judgment of local people to decide who is best to be part of the board, that frankly we should endorse my noble friend’s Motion. I urge the Minister to withdraw the regulations and bring forward revised, more sensible regulations.”
The Conservative Party has a tendency to froth at the mouth any time there is any mention of Europe. Such a tendency means that the Government is increasingly adopting policies that are designed to appease the worst of the backbench frothers – irrespective of whether the resulting impact on wider policy makes any sense at all.
Today the Home Secretary announced that the Government plans to opt out of 130 European Union measures on law and order. Or at least that was the spin put on the announcement, no doubt for the benefit of the frothers. What she actually said was:
“the Government’s current thinking is that we will opt out of all pre-Lisbon police and criminal justice measures and then negotiate with the Commission and other member states to opt back into those individual measures which it is in our national interest to rejoin. However, discussions are ongoing within government and therefore no formal notification will be given to the Council until we have reached agreement on the measures that we wish to opt back into.”
This convoluted wording reflects – just for a change – disagreements within the Coalition, but it also reflects the mess that will be created in the UK’s participation in Europe-wide cooperation on policing and crime fighting.
The Government’s intention would put at risk – amongst other things – the UK’s involvement in the European Arrest Warrant. It was the European Arrest Warrant that ensured that Hussain Osman who targeted a Hammersmith and City line train to Shepherd’s Bush in the failed 21/7 bombings was brought back from Italy so speedily to stand trial.
And as my colleague, Baroness Angela Smith, said in the Lords this afternoon:
“If the European arrest warrant had not been in place, what action would have been available to UK police in co-operating with their French counterparts to ensure that the French police were able to arrest Jeremy Forrest and ensure that he and Megan Stammers were returned to the UK in the same timescale? No one is suggesting that the European arrest warrant is perfect, but the independent Scott Baker report commissioned by the current Home Secretary strongly recommended keeping it. Yes, it could be improved and updated, and that very process is taking place now; it is being reformed. As a further example of this Statement being premature, the Government do not even know at this stage what they would be opting out of.
The European arrest warrant is responsible for nearly 600 criminals being returned to the UK to face trial. It has allowed 4,000 citizens from other European countries to be sent back to their home country or another European country to face justice. In light of some of the Government’s briefing on this issue, your Lordships’ House might like to be aware that 94% of those sent back to other European countries to face trial under the European arrest warrant are foreign citizens.”
Earlier this year I was a signatory – along with a large number of much more distinguished former police chiefs and experts in criminology – to a letter sent to the Prime Minister on this threatened opt out. This spelt out why this international cooperation is potentially so important and said:
“This hard work is producing real results today. Take ‘Operation Rescue’: a 3 year operation launched by British police and coordinated by Europol across 30 countries that led to the discovery of the world’s largest online paedophile network, producing 184 arrests and the release of 230 children, including 60 in the UK. There are now hundreds of similar cross-border police and judicial success stories and Europe as a whole is a more hostile environment for serious organised criminals to operate, making Britain safer and more secure in the process.
This is an active agenda, and we must continuously improve our international policing and justice instruments as criminal activity develops and to ensure they remain necessary and proportionate. This includes the European Arrest Warrant, a totemic issue for some. The Warrant has been improved in recent years and further improvements may be needed. But scrapping it altogether would be entirely self-defeating. It has become an essential tool in the fight against cross-border organised crime delivering fast and effective justice across Europe. Since 2009 alone, the Warrant was used to return to the UK 71 foreign nationals over serious crimes including 4 robberies, 5 murders, 5 rapes, 6 child sexual offences, 9 cases of GBH and 14 cases of fraud.”
No doubt the Government, when it has finished appeasing the frothers, will say that these benefits will still be achieved because the UK can negotiate its way back into those areas of cooperation that it wants to keep.
However, each opt-in can only be negotiated after the opt-out has taken effect and requires the approval of all the other participating EU states before it can take effect. Such a process will take months or years and there is no guarantee of certainty that the UK will be allowed to opt back in.
And this is where the frothers come back into the equation. The European Union Act 2011 – another fine piece of constitutional tinkering by the Coalition – requires that a referendum be held throughout the United Kingdom on any proposed EU treaty or Treaty change which would transfer powers from the UK to the EU. And each opt-back-in would be a transfer of power from the UK to the EU, so triggering a referendum on each change.
The effect is that appeasing the frothers now will lead to a succession of EU referenda simply to return us to the position on cooperation with the rest of Europe that we are in today. And that really will please the frothers, but will seriously damage the UK’s ability to fight crime effectively.
I went along to the so-called “People’s Launch” of Healthwatch this morning. This followed on from the presumably rather more select official launch of Healthwatch England that happened ten days ago. It took place about three floors underground with a couple of hundred local health activists packed into a low-ceilinged rather-too-small room to hear Norman Lamb MP, the (LibDem) Minister of State for Care Services, and Anna Bradley, the newly-appointed Chair of Healthwatch England, set out their vision of how Healthwatch will work.
What they said was positive and they are clearly keen for Healthwatch England (and, when they are formally established next Spring, for local Healthwatch organisations) to be effective in articulating the voices of the users of health and social care services.
The assiduous reader of this blog (you know who you are) will be aware that I have been critical of the way in which, during the passage of the Health and Social Care Bill through Parliament, the Government watered down the arrangements for Healthwatch and essentially facilitated the privatisation of patient representation and failed to ensure that Healthwatch England was genuinely independent.
Those battles were lost in the House of Lords, when – as always happened on key votes on the Health and Social Care Bill the LibDem peers voted en masse with their Conservative colleagues.
Two further big elephants remain in the room. The first is the extent to which local Healthwatch organisations will feel ownership of their national organisation, Healthwatch England. The regulations formalising the governance of Healthwatch England have yet to be confirmed by Parliament and they are being prayed against by the Opposition (the procedure that precipitates a debate and potentially a vote on a statutory instrument) later this month. Anna Bradley was keen to say (in response to my question) that it should not be a matter of ownership, either by local Healthwatch organisations in respect of the national body or vice versa. However, with Healthwatch England being formally a sub-committee of the Care Quality Commission it will remain the case that local Healthwatch organisations are going to feel that the national organisation is a top-down construct unless that have a substantial or majority stake in its governance.
The second elephant in the room is the budgets that will be available for local Healthwatch organisations. The money for these is being passed from the Department of the Health to the Department of Communities and Local Government who will then parcel it out to individual local authorities who are responsible for ensuring that local Healthwatch organisations exist in their areas. (Incidentally, these are the same local authorities which are responsible for the social care provision that local Healthwatch will be supposed to be monitoring – no potential conflict of interest there then.)
These monies are not going to be ring-fenced and there is no guarantee that all of the money provided will be made available for the local Healthwatch bodies (or even that it will be transparent as to how much was passed to the local council concerned). Norman Lamb (again in response to a question from me) lauded the principle of localism but was silent about how the Government would ensure that sufficient was passed on locally to deliver the high expectations that he had set in his earlier speech. He did, hower, report that he had increased the amount of money that is notionally being passed across to Eric Pickles’ Department for local Healthwatch. I asked him to look at the issue again …..
There was an hour’s debate in the House of Lords last night on the political situation in Bangladesh, focussing on the political violence and kidnappings of opposition politicians that have taken place there. This followed on from the oral question that I had put in the Lords back in May.
The full debate is here and my contribution was as follows:
“My Lords, we are all grateful to the noble Lord, Lord Hussain, for securing this debate on an extremely important issue. For me, this is a follow-on from the Oral Question that I asked on 23 May about what representations had been made about the disappearance of Mr Ilias Ali and other opposition politicians in Bangladesh.
In his Reply, the noble Lord, Lord Howell of Guildford, who was then Minister of State at the Foreign and Commonwealth Office, talked about the representations that had been made by the United Kingdom Government with eight other EU countries, when they had called on the Bangladesh authorities to conduct a thorough investigation into Mr Ali’s disappearance. In reply, I hope that the Minister will be able to tell us what further representations or further dialogue there have been with the Government of Bangladesh since that Answer given by the noble Lord, Lord Howell.
At that meeting, the noble Lord, Lord Avebury, who is to speak after me, raised the question of whether it was possible to engage the UN working party on disappearances. I would be interested to hear what the noble Baroness can tell us about whether that engagement took place.
Interestingly, the noble Lord, Lord Howell, in his responses to various questions on that date, referred to £1 billion of aid being given by the UK Government. I am not clear about whether he was aggregating several years together, but it is important that the Government address whether there is a relationship between the sums involved, over whatever period, and the human rights record. Is that something that can legitimately be expected as a quid pro quo for the support that this country gives to the people of Bangladesh?
The most important point to make in this debate is that the case of Mr Ilias Ali is not an isolated one. Mr Ali and his driver disappeared on 18 April, and two weeks earlier Mr Aminul Islam, a leader of the Bangladesh Garment and Industrial Workers Federation, was allegedly picked up by members of a law enforcement agency and horribly tortured and killed. In December 2011, Nazmul Islam, another opposition politician, was found strangled just a few hours after he had been dancing with his wife. His wife received very little assistance from the police when she reported him missing. I would be grateful for guidance from the Minister on her understanding of the developments that there have been in the investigations of these cases since then.
What is the Government’s latest assessment of the level of political violence in Bangladesh? We need to understand that. One of the most concerning features of this is the alleged complicity of law enforcement agencies, in particular the Rapid Action Battalion. The noble Lord, Lord Hussain, gave us a horrifying catalogue of cases which, it is suggested, are associated with their activities. There seems to be a culture of impunity among the security forces, and anyone who falls foul of the authorities is therefore vulnerable. Since 2004, there have been more than 1,600 extrajudicial killings in Bangladesh. To UK eyes, there are horrifying levels of political violence, with 300 people killed in 2006, 250 in 2009 and so on.
We have to recognise that political violence is not all on one side. There has perhaps been a trend in Bangladeshi politics for supporters of the ruling party—whichever one that might be—to feel that they are able to attack opposition supporters with a certain level of impunity. I think that comes from the broad powers that the law gives to the Government, which means that the Government of the day is, in effect, given control of the police as one of the spoils of victory.
Bangladesh is a fragile democracy and one of the poorest nations of the world—though one with tremendous potential if it is given an opportunity. The levels of political violence and alleged abuse of state power to suppress the opposition reflect very badly on the Government of that country, and on the efforts that are being made to generate wealth and development there. I have a simple question for Her Majesty’s Government. What can they do to make clear that such violence and attacks on opposition politicians are not acceptable? What further representations have been made, and what are planned? Is this being made a condition of future aid?”
Ed Miliband’s brilliant bravura performance this afternoon at the Labour Party Conference – seventy minutes without a note (beat that Cameron) – proves that the Labour Party is six months ahead of the schedule necessary to prepare for the next General Election.
Before then, the Labour Party needs to articulate the philosophical themes that will underpin the next Labour Government and crystallise those down to a (small) number of symbolic policy commitments.
The next General Election is in May 2015 – two and a half years away. The equivalent point before Labour’s 1997 General Election landslide was the Labour Party Conference in 1994. That was the Party Conference when Tony Blair in his Leader’s speech proposed that the content and wording of Clause Four be reviewed and reformulated for new times and New Labour.
The themes which underpinned Labour’s 1997 election manifesto (“The future not the past”; “The many not the few” etc) were not fully articulated until the new Clause Four was approved in the Spring of 1995 – two years before the Election. And the policy commitments (The Pledge Card”) were not finalised until July 1996 – ten months before the Election.
And today Ed Miliband set out the philosophical basis on which “One Nation Labour” will appeal to the electorate in 2015. The themes he set out today will resonate, not only with the Labour Party in the hall in Manchester and amongst Labour supporters across the country, but they will strike a chord amongst the rest of the public who can see how Cameron’s Government is out-of-touch and leading the country further and further into an economic quagmire, whilst dividing a nation and a people who will only flourish when united.