By Jessica Asato / @Jessica_Asato
Yesterday, Tessa Jowell launched an independent commission, chaired by Will Hutton of ‘The State We’re In’ fame, to look at how we can spread mutual models of ownership to more public services. The full speech can be found here, and was covered by LabourList on Twitter.
In a nutshell, she said that post-credit crunch and expenses crisis, the public mood towards both free market fundamentalism and centralised statism has shifted. If the public are, as Jowell said, moving towards organisations in which “long-term social returns are put ahead of short-term gains and which are accountable to those with a stake in their success” then this could be the moment to radically expand the use of mutuals.
Some of the comments from LabourList readers have asked why Labour didn’t do this earlier, and it’s a fair question. I expect that one of the reasons was that New Labour felt the public would find mutuals old hat, particularly since they voted overwhelmingly for the demutualisation of building societies in the late '80s. Mutuals didn’t feel as though they fitted with the times in 1997, but as Jowell mooted herself: “we walked away from the notion of ‘ownership' as a political issue. In retrospect, we were far too hasty”.
Charles Clarke has also reflected this week that Labour “did not pay sufficient attention to the way in which we regulated banking and we permitted banking to dilute its core responsibilities for enabling the economy to function efficiently and to shift towards the finance of speculation.” So there probably was an ideological block in the early days of New Labour which with hindsight was a mistake.
But we must also remember that while mutuals haven’t been the guiding light for New Labour, Blair did push hard for Foundation Hospitals – unarguably a mutual model – in the teeth of fierce opposition. I remember the Labour Party conference in 2003 where a Unison-backed NEC vote very nearly defeated Blair, while earlier in the year, the government had suffered its third biggest rebellion on foundation hospitals. The fact that the proposals had citizen power at the centre and roots in the past made no difference to those who were too concerned about resisting change and lashing out at the government.
Critics warned that it would create a two-tier NHS and play into the hands of opponents who wished to privatise the NHS. But actually it gave more democratic power to staff and users, while taking control away from the centralised NHS. Foundation Trusts now boast 1.3 million members - more than all three main political party memberships combined. As Robbie Erbmann from the Co-operative Party wrote for Progress last year “the predictions of doom have proved to be totally unfounded” and having members of Trusts changed the focus of senior managers from solely “technical goals”, towards improving “the experience of hospital patients”.
So while it’s clear Labour could have done more, earlier and faster, it wasn’t all a walk in the park. The onus is now on developing as radical plans as we can for the extension of mutual models for the manifesto. Tessa Jowell says that she will be discussing ways in which mutuals can be extended in Sure Start, social care and housing. I hope the government doesn’t ignore the idea of remutualising Northern Rock and ensuring that mutual models are extended in the renewable energy sector too.
If Labour goes big on this, we could have some decent dividing lines with the Conservatives on the future of public services. While their preferred model – the EasyCouncil - will divide the population into those who can pay for top-ups and those who will have to make do, Labour will instead seek to involve everyone - users and staff - in creating public services which suit the community, not just the individual.
By reaching back to some of the earliest influences on the Labour Party – co-operation, self-help and popular action - we could be securing a more enlightened future for our country. It’s late, but not too late.
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On the other hand I am also cynical. GP practices sre seen as a form of social enterprise based on mutual principles. What happens? GPs appear to be paying themselves increasingly well from practice "surpluses" whilst the nurses and other health and admin staff simply get a salary yet do a lot of work which generates the surplus. Take the flu vacination the govt has agreed a fee with the Drs for the immunisation programme but exactly how many will they administer?
Practices are sometimes so lucrative no new partners (GPs) are taken on except as salaried. If practices are going to become genuine mutuals they most involve all staff as practice partners.
Whilst we are on the subject, however, I think you're correct on the Tories' recent track record, but... the Tory party also existed for a long time before Margaret Thatcher came along, and at least part of Phillip's appeal is his historical account which does place conservative philosophy squarely within those realms that the left nowadays like to think of as its own back yard (Disraeli, Baldwin, Skelton etc).
I think for this reason that the left really does have a fight on its hands, and needs to offer more than just 'yeah but they're Tory, so they must be nasty' - the voters are just not buying it, however much you might think it to be true. Moves toward mutualism etc are clearly a step in the right direction - but I'd avoid thinking that occasional tidbits will be enough.
I never expected the mutualism element to be directed at local elected councils because they do not operate in the same manner. They decide things ultimately by the vote.
Mutualisation in the context of the discussion as I understand it is directed in the private and public sector where we don't vote on the decision making process.
Elected Mayor's were introduced in the hope of creating local role models and for decisive action to be taken.
The success or failure of such an idea depends on the effectiveness of the individual Mayor in question and the party supporting him/her.
Clinical Governance has it basis in standard quality assurance systems and measures based mainly around the much misunderstood ISO 9000 template. The main point being that the standard seeks to improve service by local action (QA accepts that there are always local shifts from the norm) and then feeding the impact of those improvements back to the centre. Unfortunately clinical governance was turned by Government and trust management into a top down control structure, target focussed (usually the wrong targets) and created a straight jacket approach, destroying innovation - the very thing clinical governance was supposed to encourage. The reality is Trusts and their staff 'do' clinical governance to meet Government targets and the benefits to those on the front line are often negative.
Why do I labour this point?
Because until you mutualise the NHS management system taking out all the ring fenced budgets, top down directives and flatten trust management structures the NHS will not deliver much if any real improvement - Foundation Trust or no. One of the first elements is re-inventing clinical governance so it reflects best QA practice encouraging proper analysis of error and complaint within the system when they arise but more importantly the concept of prevention which looks at how systems currently operate and how errors can be avoided in the first place.
The basis of all medical training is to constantly question why you do things in a certain way, is it the most effective way and what is the evidence for it being the most effective way. The current NHS management structures and systems are counter intuitive to this way of operating with NICE and other Quango's telling you how it will be done, like Moses coming down from Mount Sinai. The question is, as a patient, do you want vocational medical staff or robots?
Peter, simple question (not!) but what is the first thing that should be done to break this log jam?
If the intention is to "flatten management" how will that differ between a district general hospital and a large tertiary care city hospital? Would a solution for one work with the other. Indeed is it possible to "flatten management structures" in a hospital with tens of thousands of employees and an annual budget nearing a billion?
(In my completely unrelated experience in the software industry, I have worked for several companies that have professed to having a "flat management structure". I have always preferred the companies where there is more space between me - the worker - and the top management because it insulates me from all of their nonsense management-speak jargon and practices! The higher up someone gets in management, the more they love meetings, and I prefer to work rather than to talk about it.)
In which case real mutualisation does not exist then as it is overriden. I have to admit my experience of NHS management was not a good one.
thanks for the help
Danny
Have given mr Cruddas all the details and authroty to talk with the company , Just waiting to hear back from him .
Danny
Good luck too.Back later in week.
This is a great idea- and could really get the public's interest!
So good to hear something positive and pragmatic in amongst all this depressing news; just wish it had been developed a lot sooner.
Have to go again- but good reading other's comments on here.
I've always admired the Co Op/mutual societies- and really agree this could be one way forward to engage democracy in the real world- not just spin.
Great writing and work Jessica- I'd really like to hear more on LL.
I emailed the counciler that you gave me the link to but herad nothing ,
If Mrs Jowell wants to promate co-ops , How can she rectify the leaderships double standerds , I watched PMQS and it started well but Kerry at twitter said the chamber was childesh towards Mr Hughs , how does that lead?
Danny
What about Jon Cruddas?
I think the Mayor is standing down and that he is finishing as a councillor but I know someone else who can help you as the charity he works for is designed to help people in your situation.
It is not his Ward but I reckon he will help anyone.
You can contact him at alibonlabour@hotmail.co.uk
If we had a co-op parliment then that would be better .
Danny
I meant do we the other partners have Influence?
Danny
oh you mean within the institution. I think they have some, yes.
I think they have more than in most companies, you would really have to ask someone who either worked within one of these companies or a member of the Co-operative movement.
One of the Council candidates is a member of the Co-op.
Do They have influence ?
Danny
Ps sorry if this is a silly question but we here this laugne spoken lots by minsters .
pps Alex is that a no to the tshirt then ?
Well they have an ethical bank which I believe has done okay through the credit crunch. They have a political movement, and the Co-op shop I am sure you have hear of and other companies use co-operative styles too such as John Lewis.
I think there should be more of them and I think they are fantastic. Can they get Gordon Brown to change his mind or James Purnell to be a good ethical MP?
No.
Does a co-op mean a 2 way partnership? , I ask this because many partnerships have been created by our leadership but they seem one way.
Danny
A co-op essentially means that everybody co-operates and shares an interest or profit in a company. So everybody gets a real interest in seeing the company do well. Not just the guy at the top and some unknown shareholders. That was the initial idea anyway.
But I confess the news so far about the Commission appointed by Ms Jowell gives me little confidence that any sort of remotely radical approach will be taken. If, as it appears, the Commission is dominated from the outset by the Co-operative movement this is not a good start.
Worthy though classic Co-operatives are, I have seen little sign that Co-ops are moving to exploit the Co-operative Advantage - which is their freedom from having to pay returns to unproductive shareholders.
The Co-operative movement remains wedded to essentially Victorian genetically modified Company forms, and all of the governance issues - including the 'principal/agency' conflict between owners and management - which these bring with them.
The only alternative is even worse - entities based upon the arcane body of Trust law - which was essentially created by lawyers for lawyers.
IMHO what is needed is a completely new look at what we mean by ownership. Rather than taking yet another look at organisational forms, we should examine how it may be possible to create an 'enterprise model' - legal and financial framework - which is actually fit for the 21st century, particularly in view of the fact that the conventional forms of financial capital are in such deep trouble.
We should aim not to tinker yet again with organisations, but rather to enable stakeholders to mutually self organise to a common purpose.
Shareholders and mulitiple owners are regressive and single minded in that, they only contribute to speculate.
Now if stakeholders, means that the complete workforce become party to ownership, well! I think I'd like to hear a bit more about that and what that meant.
Did you email that contact I gave you who works for Tessa Jowell. I think you could and should contribute to the debate?
Lawyers for lawyers, lol that wouldn't surprise me as an agenda for our MP's. Let's hope they won't be that stupid.
Mea culpa. Clean forgot.
Will email him now.
Good man, the worst they can do is ignore you. They shouldn't though.
Mutuality and good business practise are no inevitable.
Hardly says alot for the 'progressive' wing that have dominated the scene for so long.
Having said that, I'm not sure about the idea that people want to question, continually, the public organisations that they derive goods and services from. Nor do they want to attend forums where "ideas are sought" as to "how we can do things better."
I'm a "member" of my local NHS Foundation Hospital trust. Do I feel "empowered?" Not in the least. Do I feel that I really receive information telling me "what's what?" Not in the least.
All that people want, really, is a satisfactory (value for money test?) delivery of what they are paying for via their taxes. In that regard (taxes), perhaps HM Government could issue a once-a-year advice note to be delivered with the annual P60s to say that "for every £100 you paid in income tax this year, 'a' was spent on the NHS, 'b' on Education and 'c' went on Defence and so on, down to interesting details such as how much was spent on servicing the public service net debt" (the last item seems to be exercising many minds at present).
We should not allow ourselves to be forced into knee-jerk reactions following a DMail headline. We have to recognise human nature (and what sells newspapers) : good news is not interesting, disasters are.
As for whether the public want to continually 'question' public services? No of course they don't. They have busy lives. But often if the consultation is genuine (and that is a big if) people do want to input into what services look like, how they are delivered, by whom, at what times and respond when the quality levels aren't high enough. Sure you can use value for money tests, but they often don't reveal whether nurses have a sympathetic bedside manner, whether teachers take the time to give extra support to a struggling pupil, whether council operators are sympathetic about a bereavement, or whether meals on wheels are delivered at a time when an old person actually wants a meal.
I agree that Foundation Hospitals aren't the best co-operative model - they cover a pretty huge area, don't opt-in every resident within their boundaries and tend to only consult on the big issues. There's a long way to go if we're looking for "empowerment" as you say. But if we're talking about a local library, for example, you can suddenly see the real difference having a stake in it might make.
I'm not sure what you are referring to as a Daily Mail headline reaction, but mutuals aren't. I'd like to think that the focus on mutuals comes from the realisation that the overbearing market as well as the overbearing state have failed us. When we ask the question "why can't services work like this?" mutuals give people the opportunity to shape the answer.
I've long been a fan of people receiving a receipt at the end of their hospital care stating the cost of their operation and care (usually in the thousands) with a total which then says 'Free, courtesy of the taxpayer'.
I'm not. It is the right of every citizen to have free at the point of delivery healthcare, and not every citizen is a tax payer. The NHS is a right, and not a charitable act from those rich enough to be taxed. Too many people would see your "paid for" bill as a note saying "you are lucky someone else is generous".
Anyway, if you are really interested, the figures are easily available. Hospitals are now funded via "Payments by Results" and a spreadsheet of the tariffs (the payment for each procedure) is available on the Department of Health website. (For example, my cataract operation last year cost £750 per eye, compared with the USD3500 per eye my American friends paid. [hmm the blogging editor won't let me use a dollar symbol...] It was interesting since I had two friends, one Canadian, one American, who had cataract surgery at the same time as me, and the treatment was almost exactly the same for all of us, but the costs were very telling. My 10 year old car is worth less than half what my American friend paid to get his eyesight back.)
Your comments about Foundation Trusts are not quite accurate. The legislation says that FTs must have members, but it does not say who they are. Some treat all patients as members (with opt-out) some treat all residents in a geographical area as members, others have an opt-in. Some have patient members, some have carer members, others have "anyone in the area". For specialist hospitals ("tertiary care") they even have an "anyone in the country" criteria since often their patients can come from anywhere in the country.
Experience has shown that a large opt-out membership is unmanageable and costly. Several trusts with this model have had to change to an opt-in model when they found that most members wanted no involvement at all.
I think this is an important point. FT membership is more about giving a voice to those people who want to get involved. Not so much as a "supporters' club" since that implies blind devotion, but certainly "critical friend's club".
I do take your point about teachers, nurses and council operators also providing some ("unmeasured") pastoral element in what they do, and I did acknowledge to Richard Blogger (a sound bloke!) that my "value for money" test may appear philistine.
The DMail refernce was to our Labour government reactions to DMail headlines over the years, not your particular article!
Peter I am not surprised, but this is a consequence of the flexibility of the model. I write as a elected governor of a trust that hopes to get FT authorisation early next year. There is a vague requirement for "membership engagement" but it is entirely up to the governors and the trust to decide what this means. I have spoken to governors of other trusts and found a wide range of engagement, some of which I would like to mirror at our trust. But the crucial point is that governors, although mostly elected, are not politicians (and refreshingly, governor meetings do not split along party lines). As governors, we do not have the engagement skills that politicians have and to be fair, neither does the trust, even though I believe they sincerely wish to improve engagement.
But don't be too dismissive of your local trust. Of course, a seasoned activist, someone who knows how to engage with the public, would be invaluable to them... (hint).
While I understand the point you are making, I would put forward another point. A hospital trust is a large organisation and it takes a skilled team to run it. Necessarily, this produces a certain disconnect between the management team and the patients and carers (to me, 'service users' is a very cold term). I see the FT governance model as a way to provide a reconnection. Already I am talking to a lot of people and gathering opinions of what patients and carers really want, and the trust is conducive to these ideas. So far I have not made much of a difference, but a previous patient involvement influenced the trust to move their pharmacy. This fairly small change has made a big difference to patients, and shows how useful patient involvement can be.
Thanks for your comment (re Foundation Trusts) and the information therein, and sorry about taking some time to get back to you - I "do" nights staying with my 95 year-old m-in-law - she's not too good these days.
Putting my simpleton's hat on (some may say it's never off), I would have thought what people would like to know is how many operations, how many A & E attendances, what's our "patient satisfaction" level, how many complaints, how many complaints acted on positively, how much money we spent, how much on professional clinical staff, how much on administration da da da
I appreciate that may be something of a philistine approach ("how many widgets did we make this year compared to last?") to what are, very often, very human situations but at least it would be a start to showing the public that they Trust is getting better, year by year (or not, as the case may be). We have recently seen that a "three-star" rating can be meaningless.
People in government, national or local, elected or un-elected, should always remember that tax is paid under force of law and whilst a lot of people don't do too much bitchin' and moanin' about how much tax they pay, they do have a right to see how their money is spent, without flannel or waffle.
The cost of such an annual publication need not be great. A "wrap-around" of our local free newspaper costs about £3,500 to deliver to around 35-40,000 homes ; artwork can be in the range £500 - £1,000. I am sure that people would appreciate less gloss and more information.
I'll think about the points that you have made - thanks again.
I appreciate your attention to figures, and I hope you don't mind if I call it nerdy New Labour!
Seriously the government's already got the targets angle covered. The problem is that all these figures only make sense in isolation, it is not possible to aggregate them. Dr Foster tried to do this a couple of weeks ago trying to create a league table from 13 different statistics and made a pigs ear of it. Mid Staffs came at #9 in their league table of 146 trusts using data that was obtained during the period when the Healthcare Commission (now CQC) were investigating them for poor quality of treatment. Further, another organisation called CHKS (these are all private profit-making companies) produced another "good hospital guide" this year and published the top 40 trusts. The CHKS top 40 list included 11 trusts from the bottom 40 of the Dr Foster list. Who is right? No one knows since creating a league table from 13 measurements (some related, some not) is too difficult to do.
All hospital trusts, including Foundation Trusts, have to have a public AGM. That is when the figures of where the money is being spent is published, and most trusts publish the annual report on their websites. The nerdy statistics watchers are well catered for! All trusts have to have public board meetings, but curiously FT trusts do not have to make their board meetings public. I find these board meetings very useful because there is an opportunity for members of the public to ask questions, and since few members of the public attend I've more chance to put my questions! But it does raise the question, if the public do not want to attend board meetings (3 or 4 people do, maximum) where performance figures are presented, is it worth the money paying to publish them as a wrap-around on a local newspaper?
how many complaints, how many complaints acted on positively
I think this is very important. Indeed, I think that the complaints should be made public (or at least the gist of each complaint) since this says more to me about a ward or clinic than statistics will. One thing that impresses me with my local hospital is that the chief executive reads every complaint and replies to every one personally.
The recently launched NHS choices website is supposed to be a portal for people to rate hospitals, GPs and dentists, and it also lists appropriate target statistics. It is too early to say how useful this facility is, but it has promise.
Thanks for your reply. Maybe I'm old-fashioned - "if you can't measure it, you can't manage it, and if you're not measuring it, you're not managing it," and I see what you mean about wrapping all the numbers into a coherent whole.
One of the drivers behind my comments is that we see and hear so many comments that "Labour has thrown money at the NHS and there's no discernible improvement in output." I know it's not true when measured by patient encounters and MRI/CT/Ultrasonic and other scans and I just thought that it is important that the NHS gets the message across that it is doing oodles more, both in numbers and in new techniques, compared with 1997.
As it happens, my Foundation Hospital did produce a wrap-around earlier this year. I live 5 miles outside of Chester so we don't receive the weekly free newspaper, but the wrap-around is here :
http://www.coch.nhs.uk/absolute/en/documents/admin/COC0909A-web.pdf
The only remark that I would make about the sparse attendance at board meetings is that I do think it is important, if not imperative, that public sector employees/elected representatives do make a positive effort to bring information to the people and not just rely on the people coming to them for information.
That's synonymous with MPs and councillors holding surgeries, waiting for the public to come to them. Far more effective, surely, for the elected representatives to take themselves out and go knocking on doors, that is, they go to the public.
Not a million miles between us, I venture to offer ....
Yes, Philip Blond has taken up the mantel of co-ops at ResPublica. Good for him. Whether Cameron takes any notice is yet to be seen. I was at the launch and Cameron was clear that he wouldn't agree with everything Blond does. I find it quite hard to see the Tories abandoning the major supermarkets and embracing the Co-operative. But if they do, they are not creating a new tradition, they are recognising a very old one indeed, and one which has always had its roots in the Labour Party.
possibly but I have always approved of this kind of arrangement, it was not a Red Tory who created the co-operative movement was it?
No more than he invented the use of the colour red.
Are you joking? Mutualism has been in the Labour movement for 150 years. Phillip Blond's been around for half an hour.
Kier Hardy simply called his mutualism, public ownership.
No pretentious Tory wet is stealing our great traditions ;)
Agreed and possibly, in my view your best article yet. Certainly a progessive one.