News: Frank le Duc

Does the health board serving taxpayers and patients in Brighton and Hove need a greater dose of democracy?

The committee responsible for spending the biggest slice of the Brighton and Hove City Council budget has been scrapped. The responsibilities of the Adult Care and Health Committee now rest with the relatively new Health and Wellbeing Board. What may seem like minor, dull and insignificant changes on the surface, have prompted concerns among some of those who worry about the health of our local democracy.

It may be that those concerns are unfounded, or that the devil is in the detail. Some details have still to be agreed, including the nature and extent of ‘public involvement’. But at the first meeting of the new-look Health and Wellbeing Board at Hove Town Hall last week, a 78-year-old former councillor, John Kapp, claimed to have been gagged.

Another person with concerns is the Independent councillor Christina Summers. She said: “The terms of reference are only now being debated/agreed and yet the Adult Care and Health Committee has already been dissolved and its functions effectively subsumed into the Health and Wellbeing Board.

“The only apparent means of public influence will be via the five elected members on the board as it looks as though direct public attendance and involvement will not be accommodated as the rejection of a petition submitted for (last week’s) meeting would signal.

“Although the government has afforded it a committee status, the terms of reference are recommending it operates more like a board, which implies a much more closed system.

“The only apparent means of public influence will be via the five elected members”

“There seems to be a significant amount of delegated powers proposed for the Health and Wellbeing Board and away from the council and its committees, eg, Children and Young People. Unless related directly to education or youth services, issues normally dealt with by this committee will transfer to Health and Wellbeing Board responsibility.

“There is also a proposal for the Health and Wellbeing Board to have ‘referred functions’, which effectively means that pretty much any issue that has an impact on the city’s health or wellbeing can be referred to this board rather than the appropriate committee, whether housing-related or environmental health, transport or art and culture.”

Councillor Summers said: “The council reverted back to the committee system in 2012 on the grounds of greater levels of accountability and democracy, yet now we have the dissolution of the most budget-heavy committee (Adult Care and Health) subsumed into a seemingly less accountable board that is officer-heavy and public-lite.

“This is a local restructuring decision that appears to have given public health a disproportionate amount of influence over other council services, and I’m not convinced that’s a good sign.”

Are there echoes of the attitude epitomised by Sir Humphrey Appleby, the head of the civil service in the satirical TV series Yes, Prime Minister? Sir Humphrey described our democracy as “a very British democracy”. With a reference to the Great Reform Act, he said: “Ever since 1832, the civil service has gradually been excluding the voters from government. Now we have got to the point where they vote just once every five years on which bunch of buffoons will try to interfere with our policies.”

The board has 10 voting members. It is made up of five councillors – or elected members – and five health members, mostly doctors, representing the Brighton and Hove Clinical Commissioning Group (CCG). It also has six non-voting members including senior officials and Frances McCabe, who chairs Healthwatch in Brighton and Hove.

The board oversees significant areas of public policy, it touches on matters of life and death and spends huge sums of public money. One of the reasons for changing the set up is to tap in better to government funding. Another reason is to respond to changes in law and policy. Such practicalities aside, there is a desire to make timely decisions efficiently.

There is, though, a balance to be struck. The board is also expected to be open, transparent and accountable. When the board holds its next meeting next month, there are hopes that the competing pressures will be better balanced than they appeared to be last week.