Local Government and Public Involvement in Health Bill

My Lords, as I rise to make my maiden speech I am conscious, as the son of a milkman from Bradford, of both the privilege and the responsibility of taking a seat in this place. I take this opportunity to thank those noble Lords and staff who in the past few weeks have helped me to feel so welcome, particularly the noble Lord, Lord Rogers of Riverside, and the noble Baroness, Lady Cumberlege, who supported me at my introduction. I also thank the noble Lord, Lord Williamson of Horton, and the noble Baroness, Lady D’Souza, for helping me feel at home on the Cross Benches. I am one of those strange creatures some have come to call a social entrepreneur. I have spent nearly 25 years working in the middle of a group of run-down housing estates in the East End of London, attempting to improve the quality of people’s lives and to encourage local people, for so long dependent upon the state for virtually every aspect of their lives, to take some personal responsibility for their local area and their own futures. We have had some success. When I first arrived in Bromley-by-Bow as a young clergyman on a cold November evening in 1983, I was greeted by 12 elderly people in a 200-seater church, sitting where they had always sat. It looked as though the dead had been carried out and no one had noticed. I soon realised the seriousness of my predicament. Everything was run by the state. There were virtually no businesses and absolutely no private housing, and many of the public services and structures of local government and health did not work at all well for members of my local community. You felt you needed permission from five government agencies to blow your nose. I was surrounded by people who spoke 55 different languages and dialects and were living cheek by jowl within 10 minutes’ walk of our church buildings. It was soon clear to me that there was no quick fix. To understand the real impact on local people’s lives of these realities, it would be about the long game. It would not be about seemingly endless three-year initiatives, mostly delivered by people who had no real connection to the community they were tasked to help. It would be about watching and engaging with the effects upon people’s lives of 18 different structures of the health service that have passed our doors over the years, countless reorganisations of local government and senior staff who have come and gone, many of them good people, as they have attempted to make countless local government structures work. Strangely, the realities on the ground seemed immune to this frenzy of organisation. It has been my and my family’s privilege to live and work with many East End families and individuals who have shown great resilience and enterprise when up against such a merry-go-round. I have watched individuals become active, responsible citizens not just by sitting on committees but by rolling up their sleeves and taking over, shaping places and delivering services in practical, entrepreneurial ways. During my many years in east London, I have operated 200 yards from what is now the 2012 Olympic site, of which I will have more to say later, particularly with regard to legacy. I have danced with many dinosaurs and had my feet trodden on more than once. It is from this background that I make the following general points about the Bill. First, one of the Bill’s key themes is the Government’s desire to reform local government so that it is very clear where local leadership lies and to encourage personal responsibility to be taken by clearly identified individuals. I welcome this approach. It is my experience on the ground that such an approach leads to a more effective delivery of public services. People want to know clearly who is leading them. Secondly, in east London, we have enjoyed, or suffered—depending upon your point of view—the complexity of being a pathfinder for every structural change successive Governments have invented. Therefore, I welcome the Bill’s second important theme—to foster the integration of public services under a common strategy with common leadership. I begin to have difficulty with the Bill on its third major theme of empowering citizens and communities. This is what a great deal of my work has been about. The practical experience of working in disadvantaged communities through the work of the Bromley by Bow Centre, where I have an interest, is that many people are not particularly interested in engaging with yet more committees and forums. Actually, the key to greater public involvement is to help people get practically engaged in helping them to create change for themselves. Billy Canon was a man on our estate with a difficult life experience, which left him on the edge, leading to poor health. He became an active healthy citizen because he was given the opportunity to take part in designing, building and then running a local park in a hands-on and practical way. When in the early 1990s we proposed that we—at that time, a small community organisation—would build a new health centre, showing that primary care could be delivered in a better way, you would have thought that it was a nuclear missile site we were developing, judging from the reaction of the statutory authorities. We persevered and we delivered. We proved that you did not have to have grilles to protect staff; that you could integrate a primary care team with community and voluntary staff; and that you could run and maintain high quality creative facilities full of art, rather than sterile spaces full of plastic chairs smelling of disinfectant. We challenged the often unwritten and unspoken assumptions about the quality of care and facilities that can be created and delivered without breaking the bank. We tweaked the nose of local statutory bodies and, to be fair to them, many are now working closely with us. They have raised the bar on what they consider should be the quality of services that are delivered. The health centre that we run and the social housing company with which I am associated have both won a number of awards from government, and are recognised for their practical, hands-on community empowerment. While I am most proud of the lives that that have been improved directly, many more lives have been improved by raising the expectations of health providers and planners who have visited the Bromley By Bow Centre and seen what can be achieved and sustained. However, this thinking needs to be reflected in the Bill. Social entrepreneurs are finding new and effective ways to deliver public services on the ground, and it would be wise to learn from their experience. It is not clear that the proposed local involvement networks as set out in the Bill are likely to lead to substantial change unless there is a significantly different approach. I hear that quite a lot more detailed work needs to be done on thinking through what the networks will do and how they will work in practice. In this regard, I was encouraged by what the noble Baroness, Lady Campbell of Surbiton, said today. I ask Her Majesty’s Government to consider amending the activities of the local involvement networks clearly to include the task of recommending those services which might be more effectively delivered by social enterprises than by statutory bodies. Given the focus of the Bill, I have in mind in particular those services that overlap existing statutory boundaries—for example, health, care and education—and which as a result often create difficulties in delivering joined-up provision. What I would like to achieve in your Lordships’ House is to champion the simple idea of allowing people who want to take a direct role in the delivery of services to do so, rather than assuming that it is always the state that must deliver for them. During my years in east London, I have been continually impressed by the support of Members and colleagues from this House—Lord Peyton and Lord Ennals come immediately to mind. The suggestion, as some have made, that Members of this House are in some way disconnected from the realities of the world in which I have lived, I have not found to be true. These people’s moral fibre, sheer practicality and friendship have been a great source of strength to me and my colleagues over the years, and I shall do my best in my time here to add to their reputations. Unlike some Members of the other place who came and went, Members of this House have been steadfast in their support. In fact, Members of your Lordships’ House have provided an advocacy role, enabling a small and growing neighbourhood organisation to have access to the Executive, and have enabled lessons from a local setting to enrich national policy.