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14.Jun.2011

Health secretary Andrew Lansley has accepted all the core recommendations of the NHS Future Forum report, set up after his plans to reform the NHS led to a political furore.

Under the changes now proposed, GP consortia will be known as ‘clinical commissioning groups’ and will have lay members, in addition to medical ones, and will meet in public.

Health and wellbeing boards will gain the right to refer back local commissioning plans that are not in line with the health and wellbeing strategy.

The duty original proposed for the watchdog Monitor to promote competition will be replaced by one to protect and promote the interests of patients – not to promote competition as an end in itself.

There will be stronger duties on commissioners to promote integrated care, for example by extending personal health budgets and joint health and social care budgets.

Mr Lansley said: “The independent NHS Future Forum has made a number of recommendations and we are accepting them. This has been a genuine exercise and it is clear from our response today that substantial changes have been made in the interests of patients.

“The Forum confirmed that there is widespread support for the principles underpinning our plans for change: greater patient choice, ‘no decision about me, without me’, more control for doctors, nurses and frontline professionals, a focus on quality and results for patients, more information and more clout for the public. These changes now will help us make those principles a reality.”

The heavily-amended Health and Social Care Bill will now be referred back to Parliament.

David Rogers, chairman of the Local Government Association’s community wellbeing board and also a member of the forum, said: “It’s crucial the newly proposed clinical commissioning groups don’t just focus on their own practice lists, but also work with councils on the ‘Cinderella services’ such as homelessness, mental health, learning disabilities, AIDS/HIV, dementia and child health.

“Local government has decades of experience and expertise in this field and it’s a role we’re willing and able to take the lead on. The forum’s recommendations for joint commissioning and shared boundaries between GPs and councils should help make sure there are no gaps.”

Cllr Rogers said the requirement for commissioning groups to share and agree plans with wellbeing boards, publish board papers and hold public meetings were “strides in the right direction”, as was the proposed power for councils to decide how many councillors should sit on boards.

“This should help avoid communities being dictated to from above and see people genuinely involved in decisions made about themselves or their loved ones," he said.

The report’s Patient Involvement and Public Accountability section was led by Geoff Alltimes, chief executive of the London Borough of Hammersmith and Fulham.

Its 16 detailed recommendations included that NHS commissioners and local authorities should be jointly responsible for improving outcomes where they depend on joint working and that health and wellbeing boards should set and monitor outcomes.

Boundaries of commissioning consortia should “not normally” cross those of their local authority although this would not be an absolute requirement.

Health and wellbeing boards should be the place where the local NHS and local authorities “explain and are challenged on how they are involving patients and the public in the design of care pathways and development of their commissioning plans”, Mr Alltimes’ group said.

Mark Smulian

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13.Jun.2011

Surrey County Council has said it accepts the Information Commissioner’s decision to fine the authority £120,000 for a series of data protection breaches, but argued that the money could have been “better spent” in its area.

Last week the ICO levied the highest monetary penalty so far on a local authority since the watchdog received new powers in April 2010.

An investigation by the ICO had found that Surrey had misdirected emails containing sensitive personal information on three separate occasions. Two of the incidents took place in the council’s adult and children’s services departments.

In a statement a Surrey CC spokesman said: “These incidents should never have occurred and we have apologised to the people involved.

“Immediate action has been taken to prevent this happening again. Measures have already been taken to reduce the risk of sensitive personal data being wrongly addressed and extra training on handling data securely has been given.”

He added: “We accept the commissioner’s findings but feel the money we were fined by another public sector organisation would have been better spent making further improvements in Surrey."

In an interview with Local Government Lawyer in March, Deputy Information Commissioner Graham Smith defended the size of monetary penalties being levied on the public sector at a time of cuts.

“It is important to recognise that the main purpose of a monetary penalty is to be a deterrent,” he said. “It is not a punishment – it is to deter all data controllers from making the same mistakes. So whilst I know that there have been many eyebrows raised in local authorities by the size of the monetary penalties, I know equally that an awful lot of local authorities and local authority officers will be saying, ‘well that could very easily have been us and what are we doing to make sure that it’s not us’.”

Smith also rejected claims that the public sector was a soft target compared to the private sector.

Philip Hoult

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13.Jun.2011

The government should strengthen the role and influence of health and wellbeing boards as part of its reforms, the NHS Future Forum has recommended.

The Forum – an independent group set up by the government to “pause, listen and reflect” on the Health and Social Care Bill – argued that the boards should be given stronger powers to require commissioners of both local NHS and social care services to account if their commissioning plans are not in line with the joint health and wellbeing strategy.

Its report said: “Local government and NHS staff see huge potential in health and wellbeing boards becoming the generators of health and social care integration and in ensuring the needs of local populations and vulnerable people are met.”

The Forum also suggested that better integration of commissioning across health and social care should be the ambition for all local areas. “To support the system to make progress towards this, the boundaries of local commissioning consortia should not normally cross those of local authorities, with any departure needing to be clearly justified,” it said.

Other key recommendations include:

• The pace of the proposed changes should be varied so that the NHS implements them only where it is ready to do so
• There should be a comprehensive system of commissioning consortia but they should only take on their full range of responsibilities when they can demonstrate they have the right skills, capacity and capability to do so
• Nurses, specialist doctors and other clinicians must be involved in making local decisions about the commissioning of care – not just GPs – but in doing this the NHS should avoid tokenism, or the creation of a new bureaucracy
• Competition should be used as a tool for supporting choice, promoting integration and improving quality and must never be pursued as an end in itself. Monitor’s duty to ‘promote’ competition should be removed and the Bill should be amended to require Monitor to support choice, collaboration and integration
• Private providers should not be allowed to ‘cherry pick’ patients and the government should not seek to increase the role of the private sector as an end in itself. “Additional safeguards should be brought forward”
• The duties placed on the Secretary of State, the NHS Commissioning Board and commissioning consortia to reduce health inequalities are welcome but they need to be translated into practical action
• Improving the public’s health is “everyone’s business” but should be supported by independent, expert public health advice at every level of the system. “In order to ensure a coherent system-wide approach to improving and protecting the public’s health, all local authorities, health and social care bodies (including NHS funded providers) must cooperate"
• All organisations involved in NHS care and spending NHS money should be subject to the same high standards of public openness and accountability.

The recommendations will now be considered and responded to by the Government.

Forum Chairman Professor Steve Field, a practising GP from Birmingham, said: “There is no doubt that the NHS needs to change. The principles underlying the Bill – devolving control to clinicians, giving patients real choices and control, and focusing on outcomes – are well supported.

“However, during our listening we heard genuine and deep-seated concerns from NHS staff, patients and the public that must be addressed if the reforms are to be progressed. If the substantial changes we propose are accepted by Government, then I think the resulting framework will place the NHS in a strong position to meet this objective and tackle the pressing challenges in the years ahead.”

The Forum’s reports can be downloaded here.

Philip Hoult

Details

09.Jun.2011

The Information Commissioner's Office has hit Surrey County Council with the highest monetary penalty levied on a local authority so far for breaching the Data Protection Act.

The ICO issued the council with a £120,000 penalty after sensitive information was emailed to the wrong recipients on three separate occasions.

According to the watchdog, the first incident “and most significant” of the three, took place on 17 May 2010. This saw a member of staff working for one of Surrey’s adult social care teams email a file containing sensitive personal information relating to 241 individuals’ physical and mental health to the wrong group email address.

The group email address included a large number of transportation companies, including taxi firms, coach and mini bus hire services. “The council attempted to recall the email, but was later unable to confirm that all the recipients had destroyed it,” the ICO reported. “As the information was not encrypted or password protected, it had the potential to be viewed by a significant number of unauthorised individuals.”

The second incident occurred on 22 June 2010. This saw confidential personal data relating to a number of individuals being mistakenly emailed to over one hundred unintended recipients who had, the ICO said, registered to receive a council newsletter.

On 21 January 2011, Surrey’s children services department sent confidential sensitive information, which included data relating to an individual’s health, to the wrong internal group email address. The ICO acknowledged that the data did not leave the local authority’s network, but said the breach led to sensitive data being circulated to individuals who should not have received it.

The ICO said the size of the penalty “recognises the council’s failure to ensure that it had appropriate security measures in place to handle sensitive information”.

Surrey is the fourth local authority to have been hit with a substantial monetary penalty by the ICO for breach of the Data Protection Act since the watchdog was handed new powers in April 2010. The other councils are Hertfordshire County Council (£100,000), Ealing Council (£80,000) and Hounslow Council (£70,000).

The Information Commissioner, Christopher Graham, said: “This significant penalty fully reflects the seriousness of the case. The fact that sensitive personal information relating to the health and welfare of 241 vulnerable individuals was sent to the wrong people is shocking enough. But when you take into account the two similar breaches that followed, it is clear that Surrey County Council failed to fully address the risks of sending sensitive personal data by email until it was far too late.”

He added: “Any organisation handling sensitive information must have appropriate levels of security in place. Surrey County Council has paid the price for their failings and this case should act as a warning to others that lax data protection practices will not be tolerated.”

The ICO said Surrey had now taken action to improve its policies on information security, such as the development of an early warning system which alerts staff when sensitive information is being sent to an external email address. The authority has also improved staff training and is to ensure that group email addresses are clearly identifiable.

In an interview with Local Government Lawyer in March, Deputy Information Commissioner Graham Smith defended the size of monetary penalties being levied on the public sector. He also rejected claims that the public sector was a soft target compared to the private sector.

Philip Hoult

Details

09.Jun.2011

The government’s actions in relation to localism – both in the Localism Bill and in the programmes of individual Whitehall departments – “give an overall impression of inconsistency and incoherence”, MPs have warned.

A report by the Communities and Local Government Committee also suggested that the government had failed to produce a compelling vision of what its imagined localist future would look like.

The committee said local authorities’ role in localism was unclear in particular. It pointed out that a parallel democratic structure was being established for policing, schools were to be further removed from council control, and there were to be binding referendums on council tax increases above a certain level.

The committee also noted that assets of former regional development agencies were not being transferred to local government or local enterprise partnerships.

“All these developments imply that the government may be more interested in circumventing local government than further empowering it,” it said.

On the other hand, the report said, local authorities would have a new general power of competence and new responsibilities for public health.

“The government must decide what it wants the role of local authorities to be and how it should develop, what powers they will have and how they will exercise them in relation to other bodies,” the MPs said. It recommended that each central government department set out how it will devolve further powers to local government.

The committee also called for ministers to rein in their interventionist instincts. “Central government cannot have it both ways – on the one hand giving local authorities the freedom to make their own choices, and on the other maintaining that only one of those choices is the ‘sensible one’,” it said.

“The government must make its own choice: does it wish local authorities to exercise local discretion, or does it want to continue to prescribe and recommend courses of action centrally? The litmus test of localism will be the government’s reaction to local decisions with which it disagrees.”

The committee added that the concept of ‘guided localism’ was “an unhappy compromise which is neither helpful to local authorities nor as radical as the government seems to believe”.

Other findings from the report include:

• The government’s commitment to localism and decentralisation was welcome. Power in England is currently too centralised and in the past there has been too much central government interference in the affairs of local authorities
• The explanations of localism and decentralisation that the government has provided so far “invoke very diffuse aims from which it is difficult to construct a coherent picture of the end goal”. There is little clarity about who will ultimately be responsible for what
• Some policy areas – such as the priorities of the Department for Work and Pensions – appear to have been granted an exemption from decentralisation. These exemptions, however valid, will limit the radicalism of the government’s overall vision. “They also give the impression that the definition of localism is a matter only of tone and of convenience for the government as a whole, with each department permitted to ignore localism or to adopt whichever strain of the policy will facilitate its other goals”
• The government should hold a formal consultation to gather the views of local government and other stakeholders about what sort of localism they would like to see (report’s emphasis)
• The Minister for Decentralisation will need to make “more clearly demonstrable progress in influencing other government departments than he has done so far if questions about his role and his position in DCLG are to be answered positively”. If progress cannot be demonstrated, the role may have to be moved to another, “more influential” government department such as the Cabinet Office
• The government should be wary of assuming that decentralisation will reduce public sector costs in the short or medium term. It should not be quick to declare localism a failed experiment if efficiency savings do not instantly materialise. “Indeed, the chances of localism transforming the way the country is governed may be hampered at the outset by a lack of resources to prime the pump by building community capacity”
• Ministers are not alone in needing to curb their appetite for intervention. “Changing the cultures of the civil service and of Parliament to support a more localist system will be crucial”
• Critics of localism have legitimate concerns about fairness, the need to safeguard vulnerable people, and about services underperforming. Some stakeholders and sections of the community do not trust the present forms of local democratic accountability to look after their interests when the apparatus of central accountability is dismantled. The government should consider how to help these groups hold providers to account. “In particular, the government must address the contribution to accountability that can be made by robust – and if necessary enhanced – local authority scrutiny functions”
• National minimum standards may be necessary in areas such as adult social care and child protection, but these should be formulated in consultation with local government “in order to ensure that they reflect the level of central government oversight appropriate to a localist system and do not simply recreate an overly-interventionist performance regime”
• The government should make clear the principles on which it will determine at what level different decisions will be made, and the grounds on which intervention in local services will be deemed necessary. “These questions should not be decided purely on a case-by-case basis”. A constitutional commitment to decentralisation would be one way to provide clarity about which decision-makers communities should be seeking to influence. It would also forestall campaigning groups’ reliance on national government to enforce acceptable standards of services
• The government should work with the Local Government Association to set out examples of specific ways in which the general power of competence will enable local authorities to extend their role beyond that conferred by the well-being power. “In particular it is unclear what activities currently carried out by central government might be taken over by local authorities using the new power.” The government should assess the extent to which the general power will be restricted by existing regulation and statute. “If there is in practice little room for local government to expand into, the power is likely to have very minimal impact”
• Greater financial self-sufficiency for councils is a crucial foundation for localism. The case for increasing and broadening the tax and revenue-raising powers of local authorities, and their ability to borrow, must be central to the local government finance review
• If variations in local services are to be embraced as the expressions of local choices, the legitimacy of the process by which those choices are made is paramount. As the scope of local decision-making is extended, the government must seek to strengthen and support rather than marginalise the role of local authorities
• In relation to engagement and representation, the government’s solution in the Localism Bill is mechanisms that can be triggered by any community, regardless of whether their council wants it or not. However, together with the local government sector, the government should consider how to enhance the effectiveness of the democratic tools already at the disposal of communities
• Across departments, policy developments that may individually be inspired by the ethos of localism risk entrenching silos rather than enabling creative responses to local problems. “Alternative power and delivery structures such as GP commissioning, elected police commissioners and free schools may fragment accountability, and make it more difficult to corral public resources in any one area into a Total Place-type vision”
• There is “palpable enthusiasm” for community budgets in the DCLG and the Department of Health has been praised for its enthusiasm. However, ministers in the Home Office and the DWP gave the impression of being barely aware of how they might contribute to such an initiative. “We hope that this does not presage a damp squib”. The government should publish regular reports on the progress of the “crucial” community budgets programme, which demands “a great deal more concrete commitment from government departments than has thus far been demonstrated”
• The government should develop a process facilitating local authorities’ right to challenge the centre for services it believes it can deliver better. It should legislate to give this right effect
• The government should acknowledge that the Big Society exists already to some extent, and therefore must be realistic about how much further it can grow. It has not explained how it expects to achieve a substantial increase in the number of volunteers and community bodies willing to take on the provision of services
• The intention to publish statutory guidance for local authorities not to pass on ‘disproportionate’ funding reductions to the third sector is another example of two types of localism coming into conflict. “Local government must be given the flexibility to manage its resources according to local decisions, even in instances where those decisions might threaten the development of a Big Society along the lines envisaged by the government”
• Democratically-elected local authorities have a prime role to play in holding service deliverers to account. “Local authorities are also needed as enablers, market-shapers and failsafes, evening out inconsistencies or gaps in service provision, and helping community groups and the voluntary sector to grow their own capacity.” The government should not “assume that a diversification of provision can occur spontaneously, nor can it occur without a coherent strategy to manage the risk of failure in service delivery”
• There can be no serious localism if councils are expected to transfer powers to localist institutions but still take the blame for failures in services. The government must accept that in some cases services will fail
• The forthcoming White Paper on public service reform should address the issues of the role of local government, the practical help that can be given to community groups to expand their activities, reform of commissioning processes, accountability arrangements for delivery bodies and those that take on the management of assets of community value, and how the risk of failure will be handled. The White Paper should not set out detailed solutions to these challenges, but rather the principles on which solutions can be developed locally. The government should acknowledge that some solutions will be difficult to implement without sufficient funding to support them.

Launching the report, committee chair Clive Betts MP said: "The government has to be clear about what type of localism it wants to pursue. At present there is no generally agreed definition of the term that helps everyone understand, for example, what the future role of local government will be. Consequently, most government departments have adopted whatever definition of 'localism' suits their aims, and some key areas of policy remain notably more centralised than others."

Betts added that a raft of government policies – including elected police commissioners, free schools, academies and health service reform – threatened to fragment rather than integrate delivery of better public services at local level.

He said: “The government's Community Budgets programme is intended to promote service integration, but few departments in Whitehall have so far proved willing to devolve budgetary control far or fast enough to permit localism along these lines to flourish."

Betts predicted that local councillors would need to work harder to improve accountability to local people, although he also warned that the government should not seek to dictate the methods of local accountability from the centre. “Tools like local referendums are too blunt to enable communities to express nuanced views on complex issues," he argued.

Baroness Margaret Eaton, Chairman of the Local Government Association, described the report as “bang on the money”.

“It shows how Whitehall’s ‘57 varieties of localism’ mean some departments are actually doing the exact opposite,” she said. “Even where decentralisation is going on each department is running its own private version, which means councils still feel that the government wants them to play entirely by its rules. A year into experimenting with localist policies it is now time for a clear Whitehall-wide commitment to devolving power.”

Baroness Eaton said the LGA supported calls for more wholehearted adoption of place-based budgets across all Government departments. The association has estimated that having a full place-based budget in every place would save £100bn over the lifetime of the parliament.

The LGA chairman also agreed with the committee that the government should avoid imposing methods of local accountability on councils. “Hard and fast rules on how local authorities should engage residents in decision making takes power out of the hands of democratically elected representatives and puts it in the hands of Whitehall officials, she argued. “The committee is spot on to remind Ministers they cannot have it both ways, devolving powers but telling councils how to use them.

Philip Hoult

Details

08.Jun.2011

Local authorities may be forced to take over failing care home companies to protect residents “but at a huge and unplanned cost to the taxpayer”, Unison has claimed in a report.

The union said the difficulties faced by Southern Cross may not be a one-off, with a number of other companies in the sector “on the brink”.

Southern Cross announced today that it would be cutting 3,000 jobs from a workforce of 44,000. The company had already revealed plans to defer 30% of its rents payable to landlords. It has also reported half-year losses of £311m.

Unison claimed that its research showed that the privatisation of the care industry was an experiment “that has gone seriously wrong”.

The union highlighted data showing that in 1990, nearly 200,000 of the 500,000 people in residential care were cared for in homes owned and run by local authorities and the NHS. That figure is now 31,000.

“Councils have lost much of their grant funding from central Government, leading to further cut backs in social care services,” it said. “The growing elderly population is fuelling demand for services but, unless drastic steps are taken to tackle the problem, vulnerable people could be left without essential care.”

Unison also argued that the quality and continuity of care had fallen dramatically since privatisation, “as inexperienced companies bid to run these services”.

“The cost and risk has also risen, as companies borrow too heavily, with their financial performance too weak to repay borrowings on agreed terms,” it added.

General Secretary Dave Prentis said: “The home and day care market is worth about £4bn a year, making it attractive to private companies eager to make profits. But the looming catastrophe in the sector shows that gambling with people’s care is irresponsible and too risky.

“We are seriously concerned that plans to push through the NHS reforms will lead to a similar crisis in the health service. Private equity and other private sector operators are hovering over the NHS, eager to make a quick profit - at the long term cost of care quality and continuity of service.”

Prentis added: “Typically these private equity firms buy companies cheaply, merge with rivals and then sell them on as quickly as possible. Short-term asset holding means that people and services are passed from pillar to post, with no continuity of care.

“Taxpayers have already had to bail out banks that loaned too much to private equity speculators to privatise public sector assets that were over-valued. Now taxpayers will have to pay the price again, as they will be forced to pick up the bill for collapsing companies. We need to halt the privatisation of any more public services, before more people are made to suffer in the name of profits.”

The Department of Health has insisted that the financial issues faced by one provider
do not undermine the principle of independent care provision.