The UK Experience by Malcolm Morley *
Whilst Central Government in the UK is committed to a policy of delegating power, as well as responsibility, to the regional/local level, it does not necessarily see Councils as the most appropriate bodies for that devolved power. Ministers appear to be increasingly frustrated with Councils in terms of their local community engagement, accountability and performance. This is evidenced by recent Central Government proposals that have included direct elections to Police Authorities quite separate from Councils and the concept of locally elected Neighbourhood Boards to deal with local issues at a sub Council level.
The most advanced of these initiatives, however, is foundation hospitals. The best performing hospitals are to become foundation hospitals. The creation of foundation hospitals (separate legal entities with a status between the public and private sectors) represents a significant challenge to Local Government as the only local democratic organisations.
Freed from tight central controls, foundation hospitals will have the flexibility to decide locally how to meet their obligations. Their Boards will be elected and accountable to local people quite separately from Councils.
Patient, public and staff representatives will make up a majority of the Board. Councils will be represented on the Boards but will not have automatic rights. This initiative extends local democracy beyond the Town Hall.
Local Government has had a mixed response to foundation hospitals. Some see then as an affront to the legitimate local democratic role of Councillors and Councils to represent the interests of their communities. Others see it as an experiment worth trying.
The key tests of this initiative are whether community engagement is increased as evidenced in the number of eligible people voting, whether promised freedoms and flexibilities are delivered and evidenced by local service responsiveness and prioritisation of resource investment and whether performance improves.
The first test has been answered in part. The election results from the first wave of ten foundation hospitals have just been announced. With a turnout averaging 45 per cent in the elections for patient, public and staff representatives on Boards the results look encouraging.
The figure of 45 per cent represents an increase on many Council elections that have turnouts in 30 per cent range. The figures, however, are less positive when voter registration is taken into account. Only approximately 35,000 members of the public and patients registered as members of the ten trusts to qualify for the right to vote.
This represents only a small proportion of the communities served by the foundation hospitals. Time will tell whether foundation hospitals will be a success. Councils have found that community engagement generally only increases where specific issues of local significance arise.
Health care, like many Council services, is a ‘distress’ purchase. People are often only prepared to become active and to engage with local democracy when things go wrong or where they perceive that they may potentially be negatively affected by a policy proposal.
The key decision for Councils in the UK is to decide whether or not they want to resist proposals to extend local democracy beyond the Town Hall. This decision will be informed by whether or not they see opportunities in initiatives to extend local democracy and whether or not they feel confident that they will have the public’s support.
* Malcolm Morley is Chief Executive of Harlow District Council and can be contacted via the Editor, email info@lgfocus.com.au The views expressed in this article are not necessarily those of his employer.
