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Local Health Scrutiny

Volume 637: debated on Wednesday 7 March 2018

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to make provision about health scrutiny by local authorities, including scrutiny of clinical commissioning groups’ decisions; and for connected purposes.

The Health and Social Care Act 2012 introduced radical changes to the way in which healthcare was organised. Gone were the days of large primary care trusts and regional health authorities, and in came smaller, more focused, doctor-led clinical commissioning groups and, with each clinical commissioning group, a so-called accountable officer.

There are 207 CCGs in England. They are responsible for two thirds of all NHS spending, controlling £73.6 billion of taxpayers’ money. Decisions taken by CCGs affect elective hospital services, emergency and urgent care, community care and mental health support services. The principle of clinical commissioning groups—ensuring that the health services in our communities reflect the needs of our communities—is, on the face of it, sensible. However, as with all providers of public services and spenders of public money, they should be accountable to the public they seek to serve and the decisions they make should be available for public scrutiny. That is what the Bill seeks to achieve.

The present system of public scrutiny for decisions by clinical commissioning groups is opaque, cumbersome and impenetrable to most. It is all bound up in regulation 23(9) of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013, which sets out that local authorities can refer decisions of clinical commissioning groups to the Secretary of State for Health and Social Care where they believe that proper consultation on a service has not taken place or where they consider that

“the proposal would not be in the interests of the health service in its area.”

This all sounds very good, but in reality it is a “take it or leave it” scenario. Local authorities and their elected membership are not empowered to do anything other than accept a decision or escalate it straight to the Secretary of State. That binary approach does not make for good scrutiny, nor does it allow councillors and local authorities to be involved in helping CCGs to make better long-term decisions.

That is not the only flaw in the current scrutiny system. Should a local authority make a referral to the Secretary of State, it is immediately referred to the Independent Reconfiguration Panel. However, since 2013 only 18 referrals have been received. The last four referrals, which were from Thurrock, Cumbria, the East Riding of Yorkshire and my own city of Stoke-on-Trent, saw almost a year pass between the referral to the Secretary of State being received and the report from the Independent Reconfiguration Panel being published. I am sure we would all agree that that is a totally unacceptable wait, during which clinical commissioning groups are free to implement the decision they have taken despite it being subject to a referral. I do not believe anyone would see that scrutiny process as fair or robust.

The Bill seeks to impose a 45-day time limit between a referral being received by the Secretary of State and the Independent Reconfiguration Panel making a report. Crucially, it also seeks to put any decision referred to the Secretary of State on hold until such time as the Independent Reconfiguration Panel has made its deliberations. The Bill would go further by granting local authorities a new power to call in decisions of CCGs to their local health scrutiny committee and to compel accountable officers to properly consider the views of councillors before progressing with decisions. That would be no different from the mechanisms councils already have to challenge decisions regarding public health, which have been a function of local government since 2013.

Nowhere would that new power have been more welcome than in my own city of Stoke-on-Trent. For over two years now, the north Staffordshire and Stoke-on-Trent CCGs have been pursuing a flawed and deeply unpopular plan for decommissioning and closing community care beds. Beds in Longton Cottage Hospital, Bradwell Hospital, Leek Moorlands Hospital, Cheadle Hospital and Haywood Hospital have all been lost—more than 200 in total. A referral to the Secretary of State of the disastrous “My Care, My Way, Home First” plan, dreamt up by the accountable officer, Marcus Warnes, was proposed by Stoke-on-Trent City Council, Staffordshire County Council, Staffordshire Moorlands District Council and Newcastle-under-Lyme Borough Council, but the referral took almost a year to be considered. I want to thank city councillor Joan Bell and county councillors Dave Jones and Charlotte Atkins, formerly of this place, for their help in achieving those referrals from the county and city councils.

During that year-long wait, however, Marcus Warnes carried on implementing the plan and closing much-needed community care beds. When the final report came back from the independent reconfiguration panel, it was scathing about the process. It said:

“The bed modelling presented in September 2015 has proved entirely incorrect and misleading.”

It also said:

“The circumstances of the NHS’s original decision not to consult about the closure of the Longton Hospital beds are unclear.”

The reconfiguration panel also said of Marcus Warnes’ consultation:

“It did not include any meaningful reference to the impact on community beds and hospitals.”

Frankly, Madam Deputy Speaker, if you or I, or for that matter any local councillor, was the subject of a report suggesting we had misled the public in the way we spent taxpayers’ money, we would be out of a job. I see no reason why Marcus Warnes should be any different. Rather than lose his job, however, he was appointed, against the wishes of the local authorities, as the single accountable officer for the whole of Staffordshire: a huge amount of power concentrated into an entirely unaccountable individual. In Staffordshire’s case, absolute power is leading to absolute chaos. Last week, 150 members of the Staffordshire “Care for All” campaign, led by Andy Day of the North Staffordshire Pensioners’ Convention, came to Parliament to press their case against community bed closures, because they do not have faith that the current scrutiny system is working.

That is just one example from Staffordshire, but there are many more, such as the botched privatisation of council care programmes and the CCG continuing to fine our local hospital millions of pounds for missed targets. Away from Stoke-on-Trent, there are other examples. My hon. Friend the shadow Health Secretary exposed last week how 44 CCGs were paying GPs a bonus not to refer people to hospital. That is an example of CCGs implementing dangerous policies on the NHS without proper scrutiny or public support. Cash incentives based on how many referrals GPs make should have no place in patient care and should never be used.

Such practices should be blocked, and that is why the Bill is necessary. It will provide local accountability for the decisions that are taken by CCGs. It will provide new scrutiny powers to democratically elected councillors to rein in unaccountable CCG chief officers. It will ensure that local NHS services are scrutinised in the same way as council-provided public health services. The Bill will come too late to challenge the decisions in north Staffordshire or to support the 17 referrals that came before it, but it could help to ensure that future decisions by all CCGs are genuinely in the interests of the communities they are there to serve. There is still a lot more to do to return genuine accountability to the NHS, but the Bill would be a start.

Question put and agreed to.


That Gareth Snell, Layla Moran, Jack Brereton, Jeremy Lefroy, Diana Johnson, Rosie Cooper, Mike Gapes and Ruth Smeeth present the Bill.

Gareth Snell accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 6 July, and to be printed (Bill 178).