Concerns have been raised by members of the council’s social services committee that increased integration with the NHS may lead to a reduced level of democratic control over council funds.
Three councillors have spoken to The Shetland Times this week to express their disquiet over the proposals for a ‘health and social care partnership committee’ (HSPC), due to be discussed at the full council meeting on Wednesday.
If agreed, the committee would eventually take on responsibility for strategic planning and policy-making in a raft of areas previously dealt with separately by the NHS and SIC, including adult social work, criminal justice, mental health, dental services, primary medical services, ophthalmology, podiatry and community nursing.
The committee would be made up of seven councillors and seven members of the health board. It would also include further ‘non-voting members’ from both organisations, as well as from the voluntary sector.
At a seminar on the subject earlier this week, several councillors expressed serious reservations about aspects of the proposal. Chief among these was that, by diluting the influence of elected representatives in significant areas of policy, local democracy could be undermined.
A committee that was 50 per cent unelected would have decision-making and budget-allocating powers on matters that had previously been decided by councillors, fully accountable to their constituents.
This is something that worries Allan Wishart. While he’d had “some reassurance” during Tuesday’s seminar, concerns remained, he said, over the loss of “democratic control” and the potential clash of cultures between the two organisations.
“My fear was that we have two different cultures” he said. The NHS is “a board that’s appointed, including officers responsible to Edinburgh, to the government”, while the council is “locally elected, and directly responsible to the people of Shetland.
“I just felt that there could be a fundamental mismatch and culture difference there in the whole way it’s set up and runs.”
One particular change that worries Mr Wishart is that decisions will no longer be made by a vote among members. Instead they will be made on the basis of consensus.
“Now that’s not the way that a local authority works” he said, “or democratic bodies. That concerns me because I think there’s nothing like a good debate and a vote to be open and to give evidence of the democratic system working. Obviously, it’s stood the test of time and is valuable.”
Under a bill currently being considered by the Scottish parliament, all local authorities will be required to develop community care partnerships with the NHS. Until that bill is enacted in April 2015, the HSPC will act as a “shadow” committee, though the extent to which authority would be delegated to it has yet to be made clear.
None of the councillors we spoke to have any difficulties with the principle of integration; all, in fact, wished to emphasise the necessity of partnership with the NHS. Their concern, rather, is with the erosion of accountability, the lack of detail in the proposals and the pace at which those proposals are being progressed.
According to Billy Fox, establishing such a partnership committee at this stage is “very much jumping the gun”. The council were “second guessing what’s going to come out of the bill” he said.
“There’s nobody saying no to integration and there’s nobody saying that we shouldn’t actually continue to integrate, but to move to this ‘halfway house’ committee, which will have consensus decision making and undermine the democratic process – I’m not even sure that we as a council have a mandate to do that.
“I mean, can the Scottish government actually ask us to do that? Do they have a mandate to tell wis to do that? Do we have a mandate fae wir electorate to do that? I dunna think we do.”
Another member of the social services committee, Gary Cleaver, emphasised this point. The council is unwise, he said, to be pushing ahead with their plans while the government is still debating the bill.
“I think that Shetland Islands Council is maybe going too far down the road on a model which, although it’s reflected in some of the elements of the bill, is not the only model that’s being suggested.
“There’s nothing wrong with being well prepared and having a good discussion about this. But I’m just a little bit concerned that we appear to want to commit to one very distinct structure that may not actually 100 per cent fit with what we’re being asked to do.”
Orkney Islands Council (OIC) has already imple-mented a similar partnership model to that being proposed in Shetland, and rumours are now emerging that all has not been plain sailing.
A senior source at OIC acknowledged that there were “barriers” to the kind of integration that had been established.
“I think it’s fair in saying” the source admitted, “that while Orkney has made progress in some respects, they’ve had their difficulties as well”.
The chairman of Shetland NHS board Ian Kinniburgh said that he did have a certain degree of sympathy with the councillors’ concerns over democratic accounta-bility.
However, he feels the partnership model that is being proposed does not, in fact, threaten that accountability.
“I can clearly understand” he said, “both from a philosophical point of view but also from an operational view, a nervousness about appearing to potentially lose a degree of control.
“But certainly the arrangements as they are suggested at this point in time, in practice, wouldn’t remove that degree of control until the bill goes through [in 2015].
Mr Kinniburgh said the benefits of working together far outweighed the risks. And these benefits had already been demonstrated.
“We’ve been working jointly at the grassroots level and at some of the management tiers in trying to join services for almost ten years. We’ve had some joint appointments between the two organisations in place for that period of time.
“We’ve seen a lot of the potential benefits that we could get from joint working, [but] the grassroots – the staff – have in the past told us that the biggest obstacle that they perceive is that we don’t have the joined-up thinking at the top.”
Mr Kinniburgh also took issue with the councillors’ suggestion that the proposal was being moved ahead too quickly, in advance of the bill’s passage through parliament.
“If you accept the principle that making decisions in possession of the full set of information will help you make a better decision than if you only have half the picture, then why would we delay doing that?”
“I think it would be unfortunate if we lost the opportunity to take this forward, but I fully recognise that, at the moment, both the health board and the council have an opportunity to either play into this or not.
“Personally I would hope that we grasp the nettle and try and use the time that we have between now and the bill kicking in to best effect … Because we’re talking about very, very significant services for very vulnerable people and it’s important that it works.”
The Shetland Times editorial comment.