Workshop 3: Two sorts of accountability
Chair - Mike Young
[Flipchart notes]
Health Authority accountability: Chair to Region
Local Authority accountability: Officers to Members
Terminology: Service users, consumers, citizens, voters
Consumer movement has moved from individuals to citizenship - a useful contribution to the debate and to skills and mechanisms - understanding what it means to speak on behalf of others, as opposed to tokenism
2 cultures opposed - Local Authorities feed their electorate - postcoded local democracy We need people finding the time to volunteer. Set about trying to better things for others. The NHS is the most closed shop. Need something high-profile to get people to know about CHCs. How to get involvement?
Differences in culture - aren't HAZ's meant to get people together? Bradford has done this around particular examples - e.g. diabetes, mental health. NHS less approachable.
HAZ's - in some areas do bring NHS and local authority together. To get culture changes you do need people with the right attitudes and training and sharing best practice.
NHS compared with education - the relative importance of national (standards) and local (operational). Do they (NHS and education) pull in different directions?
Lets make some constructive suggestions. Look at the wider determinants.
* Locally how do we get to "hard to reach" people?
* Community Development trains local people to ask about local needs. Statutory bodies can then fund more of that, as well as what is needed
* Scrutiny -Too many bodies to scrutinise?
Intermediate beds - in rural areas this is mainly private and may be difficult to access because of transport problems. All these changes have been thrown at us and major mistakes will be made.
Local Authority/social services accountability - differences between professionals and elected members. Information exchange is needed at various levels. Good staff and community should be able in influence decisions about services. Recruitment and training makes a lot of difference.
Everything starts at the patient. Boards aren't effective. Too much paper and meetings. Too many silent people. Need a powerful knowledgeable person with roots in the community.
Inequality of access to health services is an NHS issue, not an LA issue.
Accountability should publicise decisions and reasons for them.
Asking people what they want leads to people expecting you can promise it. Can we (NHS or LA)? Is this why fewer participate in public activities?
Accountability in Local Authorities - are they credible as representatives if they don't deliver services? (though Best Value doesn't rule out local authorities as providers) Las aren't always good at listening
Democratic deficit - should we address it by moving public health back to LAs from health management? Public health got separated from Local Authority and floated off. Need for training in PCTs etc to look at the big picture, but also in Las. Where things are working well you can build on that. Where will Councillors get time and resources to do scrutiny with?
Not enough consultation with people about the services they want. They'll have ideas about how services can be delivered. Voluntary sector can give their view but could be funded to ask more widely.
We should be talking more about citizenship. We all have that responsibility.
Address cultural diversity much more, especially in areas of small minority populations, in consultations and in accessibility of services. Social Services and NHS should not make service delivery more complicated.
Accountability and citizenship: some areas high turnout to vote while others are very low because life is hard. Communities may not be articulate and may be excluded from the democratic process so we need other ways of being accountable, e.g. by asking people what they feel affects their health. People know money is limited and don't have unrealistic expectations.
Some local community plans are the result of consultation. Some Local authorities have joint posts with health authority. But how can local authorities do scrutiny - not enough time and not well enough informed.
Will scrutiny committees work like the health select committee? Could have enormous impact if publicised and televised.
Some local authorities think scrutiny will give better control over NHS consultants.
The way we consult with the community is very important, especially personal contact rather than the traditional public meeting. We need to listen more and not go in with pre-conceived ideas.
Workshop1 Participation
Workshop 2 Local democratic accountability
Workshop 4 Delivering an effective service