The different faces of the Charity Commission

Last Friday saw a very thoughtful editorial by the Editor of Third Sector Stephen Cook, on the Charity Commission. The points he make are pertinent and highlight the problem there now is with the Commission which is now concerning more and more of us in the sector. 

He writes,

"The Charity Commission has been busy recently, and it’s instructive to examine three of its latest publications for their differences in style and message. The first is the regulatory alert of 3 March, issued after the news that two charities had funded Cage, the pressure group that has suggested that Mohammed Emwazi, aka Jihadi John, had been radicalized by his contact with the security services; the second is a statement the commission issued on 6 March about charities funding Cage; and the third is an operational case report from 10 March on the Beatbullying Group, the charity that went bust last year.
The regulatory alert is a measured, helpful and factual reminder to trustees that they must undertake reasonable due diligence to protect the funds and reputation of their charity when making grants to non-charitable bodies. It reminds them that the funds should only be used for activities that further the purposes of the charity, directs them to commission guidance on decision-making by trustees, and points out that some charitable purposes such as community development and the promotion of human rights can be difficult to interpret. All very sound.
The statement on charities funding Cage is a different kettle of fish. It says the commission is concerned that the past funding of Cage by the Roddick Foundation and the Joseph Rowntree Charitable Trust risks damaging public trust and confidence in charity, and that recent public statements by Cage have increased that risk. "In these circumstances, the commission took robust action and required further unequivocal assurances from the two charities that they have ceased funding Cage and had no intention of doing so in the future," it says.
It then goes into detail about how JRCT did not initially provide within a 24 hour deadline "an unequivocal assurance that the trust would not make any future grants to Cage under any circumstances", but did eventually give an assurance that "it will not fund Cage either now or in the future."
There are two notable aspects to this document. The first is its punitive tone and the way it dwells on the interchanges with JCRT, leaving the impression that a charity is here having its nose rubbed in it in public. No wonder the JRCT said in its own statement that it had been subject to "intense regulatory pressure" and that some charity lawyers say privately that this statement "smacks of regulatory muscle."
More seriously, the statement raises the concern that the commission is fettering the discretion of trustees. Normally it quite rightly insists that trustees’ discretion is paramount – as, for example, in the setting of senior pay levels - and here it appears to restrict that discretion. Charity lawyers are asking what power the commission was exercising when it required the JCRT to give unequivocal assurances about its future decisions, and feel that no explanation has yet been offered.
Similarly, the statement says the commission expects that "all charitable funds are used according to their charity’s purposes and in the way that the public would expect." This is an alarming proposition, surely. Who is to be the arbiter of what the public would expect? Different parts of the public expect different things. If the arbiter is to be the board of the Charity Commission, the way would be open for it to rule out funding of causes it deemed unpopular. And yet one of the most important roles of charities is to espouse causes that are not popular, concentrating instead on principle and morality, and challenging prevailing views and policies. What would happen, under such a regime, to charities supporting refugees and migrants or seeking effective methods of rehabilitating paedophiles? The adoption of unpopular causes by charities does not in itself damage public trust and confidence in charity - the issue is more subtle than that. Again, the commission has offered no rationale for this aspect of its statement.
The third document, the operational case report on the BeatBullying Group, is different again. This was a charity that was a darling of the government, which gave it £1.3m three years to expand its activities, but went out of business late last year when grants it was counting on failed to materialize. The report asserts that  it is up to the trustees to make decisions that a reasonable body of trustees would make "and we found that they had done this and had fulfilled their duties." And yet a few sentences earlier the report says "BeatBullying was not in compliance with its own reserves policy and had no reserves." It is hard to avoid the implication here that the commission considers it a reasonable decision for a trustee board to ignore its own reserves policy.
Overall this report, laced with sympathetic remarks about BeatBullying’s well-meaning attempts to avoid its regrettable fate, reads like a throwback to the days when the commission was more indulgent towards charities, and not like a product of the brave new world where "robust" is the watchword and the commission’s chief executive has said that charities should no longer get the benefit of the doubt.
How well do these three publications sit together? The speculation might be that the first was produced by the lawyers, the second was more a reflection of the views of senior board members, and the third may suggest that approved charities can escape robustness. But, all in all, the situation is quite confusing: could the real Charity Commission please stand up?"
 
As ACEVO has argued for many a month, we need a Commission that balances its role as regulatory enforcer with that of adviser and supporter of charities doing a difficult job. Recently, there has been a dangerous slip towards policing at the expense of advice. This has been seen dramatically with what appears to be the general approach to Muslim charities, where the wide perception of bias in that community threatens the good work they do and which we should support. This approach is a reflection of the wider discourse which seems to think we fight terrorism only through security measures and more legislation - instead of work to build up community leadership, and the institutions of society which bind people together in common cause. Muslim charities are crucial to this work - as are many parts of our voluntary sector - and they should not be uncessarily undermined. Stephen Cook’s point about the Commission’s very different approaches to BeatBullying and to faith charities is instructive.

I see in this morning’s Times an extraordinary, related story looking in depth at the Plymouth Brethren and the £13m they have secured in tax breaks from Government, despite a range of often unpleasant traditions and practices amongst their followers, and after alleged intense lobbying of regulatory authorities. This is another example of the discrepancies in the Commission's behaviour towards different types of charity.

Stephen Cook is also right to warn about the dangerous and unprecedented view the Commission now promulgate, that charity funds must be used in a way "the public expects". Who decides what it is that "the public expect”? 'Public benefit' is already clearly defined in case law and has been much-debated even in the last few years. And charities have for centuries been at the forefront of developing social boundaries, so these definitions are constantly evolving. 

I remember the time when needle exchange was highly controversial. I’m sure "the public” would not, back then, have wanted this activity to go on. The same applies to charities' work in helping asylum seekers or refugees. Charities should act in accord with their mission and with what works for beneficiaries. An additional and new regulatory test that this must also accord with "what the public expects" is not a feature of charity law, nor is it the job of the regulator to interpret the public's view.

These are warning signs that all is not well with our regulator. Far from maintaining trust in our sector they may well end up undermining it, and that damages us all. I'm glad that Lord Low is heading our Commission into better regulation and can examine these issues in more depth.

Charity Commission and Oxfam

The Charity Commission have issued their long-awaited opinion on Oxfam. Two issues were investigated: Oxfam's work in Palestine, and their ‘Perfect Storm’ Twitter campaign about poverty in the UK.

On the first point, Oxfam were exonerated completely. On the latter, I think, things got silly. The Commission concluded that “the tweet could have affected the views of those who received it and could be misconstrued by some as party political campaigning”.

Clearly, charities must stick to the rules. The public trust and value charities as independent organisations. The Charity Commission issues clear guidelines - its document ‘CC9’. They say charities may campaign politically, so long as they are not party political. This can be demonstrated by good governance and a transparent approach to decision making. So far, so good.

But there’s a serious problem when regulators start trying to rein in Twitter. 140 characters isn’t usually enough to make your meaning totally clear, even if there’s a picture attached. Hostages to fortune are commonplace. You have only to look at Emily Thornberry MP’s recent fate to see what harm can result. 

In most such controversies on Twitter, much of the meaning is in the eye of the beholder. It’s anachronistic and unworkable for a regulator to control every Tweet people make. We’ve been here before when the Electoral Commission suggested the Lobbying Act should apply to Twitter, earlier in the Autumn.

The Charity Commission’s comments on Oxfam simply won’t work on a practical level. It is all very well to argue, as they do, that Tweets need proper context. But let’s be realistic about what is possible in our world of instant messaging. Its impact is quick and charities are rightly seizing this new medium as a way to reach supporters, spread their messages and carry out campaigns - to ignore it would be to neglect their duty. Its nature means we can’t “ensure there is written authorisation and sign-off procedures”, as the Commission propose. Twitter is too quick and non-hierarchical for that to work.

So what lessons for the future? It’s increasingly clear that 20th-century regulation and 21st-century campaigning very often don’t match. The best campaigning is often provocative and derives its power from shocking people from their complacency. This drives social change, and draws attention to charities’ work for their beneficiaries. It would be irresponsible to try to smother it, under a new layer of bureaucracy. As ACEVO’s General Election Manifesto says, we need a ‘free society’ where social organisations are free to speak truth to power.

The General Election ‘long campaign' started yesterday and it’s a good time to debate the future of our ‘Free Society’. ACEVO’s Commission on Civil Society Regulation, chaired by lawyer Lord Low of Dalston, will consider how government can help secure charities’ and voluntary organisations’ place in the 21st century through good regulation. It’ll report in early March, and advise charities and government on a new generation of legal oversight.

But in the immediate future, let’s be robust in defending charities’ right to speak out. They have a duty to follow their mission. That may mean being ‘political’. They aren’t being ‘partisan’, even if politicians disagree with them and accuse them of taking sides.

I’m tempted to ask what the general public would rather see. On the one hand, a lively online democracy with charities campaigning to draw attention to neglected causes, bringing to bear the weight of their expertise and evidence-gathering. And on the other, a heavily-policed, hierarchically-controlled Twitter space, with all institutional voices too timid to speak their minds for fear of prosecution. We already have the former, and in my mind it works very well. Charities are an independent, non-party, political force, unafraid to speak the truth to power. Long may that last.

Aaronovitch, Leeds and Winterbourne

Another great ACEVO leadership lunch yesterday, this time with Dave Aaronovitch – the well known broadcaster, journalist and Chair of Index on Censorship. I say ‘Dave’ – as I knew him when he was one. But as he said when he got to 28 it became David so he always knows if someone calls him Dave it’s a very old acquaintance. As I said to him, the same applies to me. Only very old friends call me ‘Steve’ (‘Tony calls me Steve’ as a famous Guardian profile of me headlined).

But I digress. We had a fascinating discussion on the state of the electorate and likely outcomes in May. As he had said in his Times opinion article that morning, pace Alice in Wonderland, ‘none shall have prizes’ next May. And perhaps the parties don’t even want to win. Very interesting also to hear from Peter Wanless, CEO of the NSPCC and author of the recent inquiry into historic child abuse records at the Home Office. He had been on the BBC the day before having to contradict the PM who had said his report showed there was no cover up. ‘He's wrong’ he said trenchantly. Good for Peter – a fine example of a third sector leader speaking truth to power.

Earlier in the week I was at the Leeds Jewish Welfare Board for an ACEVO regional forum; a chance for our Chief Executives to get together to network and share. As is so often the case, thoughts were much around problems on governance and money. Interesting to speak to Liz Bradbury who runs a superb outfit that supports young and old with practical companionship and a raft of services, as well as running a service for people with learning disabilities. We had a chat about my recent work on the Winterbourne report. Indeed another member there talked to me about how they are setting up a new community facility, with social finance support, to enable people to move out of hospital and back into the community.

The report of my steering group on Winterbourne is now finished. Our last meeting has taken place, and the report is off to the printers. It will be launched later in the month. We will have to wait to see the recommendations published  and how they are then received. And then the real work begins in implementing what we say.

I get a strong sense of consensus around what we are saying but we will see. And after all a report is only as good as what people do with it. After 3 years of failure to deliver on the pledge to move people from inpatient institutions there is cynicism around whether there will be action. But I’m optimistic. From what I have heard from all those who have taken part and been involved there is a strong sense that we can now move forward on an action plan for change. We shall see.

But before we get to that launch its the ACEVO Annual Dinner and Annual Conference next week. We will have a rather splendid document to launch.... but I'm not saying on what. And our guest speaker will be old friend Eric Pickles, the Secretary of State for Communities of Government. And we are overflowing with guests like Francis Maude MP, Simon Stevens, Will Hutton, Lady Smith, Lord Wood, and our Minister Rob Wilson MP. But the stars will of course be the charity and social enterprise CEOs!

What are the Charity Commission up to now?

Had anyone noticed – before last week – that the Charity Commission this year produced a new ‎‘Statement of Regulatory Practice’?‎ Certainly it hadn’t been much discussed. It appeared in its 2013-14 Annual Report, published in July, and was mentioned by Paula Sussex in a speech last Tuesday. Stephen Cook’s excellent editorial in Third Sector on Friday was timely in drawing attention to it and the surrounding debate. At ACEVO we’ve been investigating the new statement for a few weeks; it is important and concerning.

The new Statement of Regulatory Practice has added an interesting regulatory area that seems not to have appeared before in this form; the regulation of ‘‎improper politicisation’. No mention is made of this point in previous reports.

The full statement reads:

‘We will be alert in particular to fraud, terrorist activities, the abuse of vulnerable beneficiaries and to improper politicisation.’

The closest equivalent line in the previous Annual Report instead focuses on:

‘Issues of fraud, financial abuse, terrorism and concerns about the safeguarding of vulnerable beneficiaries are among the most serious of abuses and we will continue to concentrate on tackling these problems.’

No word on ‘politicisation’ there.

Of course charities need to avoid being partisan and party political. The Commission has the job, as regulator, to enforce the law on this matter. But how exactly will the Commission – whose role is explicitly non-political and in fact quasi-judicial – properly determine what is ‘politicisation’ let alone when it might be deemed ‘improper’? The Commission’s own guidance document CC9 states specifically that ‘campaigning and political activity can be legitimate and valuable activities for charities to undertake’. Indeed if you invert the phrase this would mean that ‘proper’ politicisation is fine. What does all this mean in practice? And who is to judge?

This might all be discarded as merely a clarification of existing practice as set out in CC9 (in its latest post-2008 version). But given the tone the Commission has set over the past year or so charities might be right to wonder whether the definition of what political work is deemed ‘proper’ might vary according to political whim. Either the Commission is subject to political influence and so it shouldn’t be allowed to make judgments like this, or it is indeed a quasi-judicial body and thus the independence of its regulatory activity should be closely guarded.

Further down in the Statement of Regulatory Practice comes an assurance that ‘we will respect and protect charities’ independence’. How do these two statements add together?

I’m concerned that in the current debate around charities’ duty to speak out and to campaign, the focus on preventing ‘politicisation’ might curb our right to independent voice as long established in law – and as is laid out in CC9. In the recent debate about the Oxfam ‘perfect storm’ advert it would have been good to see the Commission more clearly defending our right of free speech from the outset. I’m sure they will be clear in their views that the advert fell well within their Guidance and will protect our independence from political attack. 

At worst this addition to the regulatory list may signal the Commission is prey to ideological winds, as exemplified by the recent choice of Frank Prochaska to speak at their Annual Public Meeting, comments from its Chairman or the failure of the Commission to argue for charity exemption from the Lobbying Act. If, as Stephen Cook suggests, a wider review of CC9 and charity campaigning guidance will soon be afoot, if not before the election then later in 2015 or 2016, it would be worrying to begin the review with the Commission already having set out a clear, hostile view that says charity campaigning and political activity should be curtailed.

We saw in our Red, Blue and Yellow Books of the Voluntary Sector that the big political parties are all thinking seriously about charities, the regulator and civil society’s relationship with politics. Let’s hope that the run-up to the General Election gives us a serious debate on this issue, and that MPs take their seats next May better informed about charity political activity and ready to carefully defend us against any efforts to curb our campaigning. Our independent speech must be protected!

Winterbourne update

A number of key meetings last week and this. First, with Norman Lamb MP, the Care and Support Minister (who will, incidentally, be speaking at our Lib Dem Conference event). He was the politician who made the brave pledge to move people with learning disabilities into the community and away from institutions like Winterbourne. The pledge has not been honoured, and I know he feels deeply about that, but he was right to make the pledge and right to be holding NHS England's feet to the fire (and indeed mine) on achieving it now. I was able to outline the key planks of the work we are doing in the steering group. We discussed the issue of closing facilites: clearly some are not for the NHS to close, but I argued there is a duty to spell out the journey that means we will close institutional care - so that care and support in the community is the norm not the exception. Of course this means we have to develop community facilities, and the third sector's role here is crucial. We also need proper crisis support. But clarity on the objective is crucial. 

And I saw Norman again at a summit organised by him and the third sector organisation ‘Change’, which I have blogged about before. Philippa Brangan was able to demonstrate what work they do in promoting and supporting professional work for people with learning disabilities. What came across to me is the crucial importance of securing a transfer of power from the state to the citizen in the work we do on a commissioning framework. Norman raised the question of giving people ‘the right to challenge’. Music to my ears. In fact when I presented my report on ‘Choice and Competition’ to the Cabinet during the Health and Social Care Act Listening Exercise, the right to challenge for citizens in their health service was a key recommendation. The NHS Constitution  states that ‘the NHS belongs to the people’ yet this is hardly evidenced! So we will look at the potential for empowerment, challenge and personal budgets. However personal budgets require choice. That requires a bigger provider market and so the role of the third sector - as advocates and campaigners as well as providers of citizen focused services becomes even more crucial.

The clock is now ticking as we aim for our last meeting on the 27th October and all of the discussions with PLD and families to support that. I was able to report to the Department of Health assurance group (chaired by Norman and Gavin Harding, who has been an invaluable member of my steering group) on Monday about what we are up to. Frankly we need to focus on outcomes as what I'm told is people with learning disabilities want progress and action, not more discussion. Exactly what Gavin emphasised on Monday. And what we will try to do at our meeting later today. 

Winterbourne View, progress

A recent article by my old friend David Brindle in the Guardian highlighted the problem we face in moving people with learning disabilities out of hospital into the community and reflects the background of the work we are doing on a commissioning framework in our NHS England steering group.

The problem we need to tackle is that more people with learning disabilities are being placed in hospitals like the one at the centre of the Winterbourne View scandal than are being moved out, despite a brave government commitment to move all people out of inappropriate inpatient facilities. Latest official figures released four weeks ago show that in the three months to the end of June, 358 people were admitted to so-called assessment and treatment units in England. Only 261 were discharged.

A subsequent review by the Government following the scandal concluded that personalised care and support in appropriate community settings is vital. There is a strong consensus around that aim. But so far the transfer programme was supposed to have either moved people out of the units by 1 June or given them a firm date for discharge. So progress is painfully slow. However much work has gone on and since taking this area of work on, NHS England has put in place urgent actions to move towards securing the goals on transfer.  I believe we have an opportunity now to make real progress and secure the community support for people with learning disabilities that they and families want. The current system places too much of the power of decision out of the hands of people with learning disabilities and their families and we need to devise a system that shifts that power from the state to the citizen. That aim must underpin our work in devising a new national framework.

The latest figures, collected by NHS England, show that the number of people given a date for transfer did double over the three-month period to 577. However worryingly, in almost four in 10 of these cases, the local councils concerned did not know that the individuals would be returning to their home communities.

In 50% of all 2,600 cases – which include 147 children – councils had no idea that they would need to help make provision for people returning from Assessment and Treatment units.  Jan Tregelles, the CEO of Mencap is quoted in David's article: "We know people with a learning disability need joined-up local health and social care support. This is clearly not happening. When this is not in place, people are more likely to end up right back in the very units they are being moved from."

NHS England has recognised this and with the steering group I have been asked to chair we are looking at how a national framework for commissioning and social finance could enable the build-up of community support. We are reviewing the work that has already gone on so we can build on that. The aim is "personalised care and support in appropriate community settings " and a shift to a system that emphasises citizen rights in the care system. Our last steering group meeting looked at an initial paper from Bob Ricketts, someone I regard as one of the country's top experts on commissioning which posed questions we need to consider in developing our recommendations on commissioning. We also looked at issues facing a large scale move to community support in the training and development of the workforce. And shortly an expert reference group on social finance will meet to examine how to fund community support. And as we committed, we will be publishing the minutes and papers of the meeting from last week on the NHS England website.

But this work is one part of the much wider ongoing system change that is needed. If this is to work in practice, there needs to be an ongoing engagement and dialogue with the people with learning disabilities, and their families and carers. Without that, this simply will not work.

It’s a Dog’s life....

I hate those fascist like signs that are increasingly seen in our parks and public spaces “No Dogs". The sort of signs that call for civil disobedience from us dog lovers. They’re stupid too, when we should be encouraging more dog walking as we all understand better the dangers of obesity. I'd have dog walking on the NHS for diabetics!

Anyway this is just a lead in to say farewell to the wonderful Clarissa Baldwin who is stepping down as CEO of the Dogs Trust after 28 years. An inspirational and much loved leader. I well remember my visit out to see her at their HQ. She is perhaps best known as the author of the slogan “A dog is for life not just for Christmas". And the Dogs Trust is in safe hands as they have appointed Adrian Burder who has been working at the Trust for some time and knows the ropes. Good luck in leading them. I should mention that both my Chair and I are Dogs Trust members! And Clarissa was a longstanding member of ACEVO.

And finally, another huge irritation to us dog lovers are the problems in finding places to stay that aren't sniffy and irritating about dogs. Help is at hand with a blog written by a dog!  Phileasdogg... http://www.phileasdogg.com/

See this video snip...

https://www.youtube.com/watch?v=gQh8dIGqXc4

Now I'm off to Warwick to talk to the CEO, Jim Graham, of Warwickshire County Council about how to maximise the use of the third sector in delivering better citizen focused services and ensuring the council hears the voice of their local communities. A not un-agreeable place to spend the day though I doubt I’ll make the castle... The Hound is off in Battersea Park.

Brixton Boys and the death of political discourse

What a treat to listen to John Major on Radio 4 this morning! He was born just down the road from me on Coldharbour Lane and talked about his Brixton days. He, like me , was a Lambeth Councillor – though not quite in the same era!

What I found reassuring was his welcoming attitude to immigration. He was pointing to his own experience of hard working and ambitious immigrants in Brixton. Such a change of dialogue from the nasty, divisive speeches we get these days from many politicians who want to pitch to base instincts and spread scare stories about scroungers and welfare cheats . This discourse is corrosive to social cohesion and builds on people’s prejudices, without so much as a shred of proper evidence, as opposed to pub room chatter and anecdote. Or should we call this ‘policy making by the Daily Mail’?

But political discourse is pretty dismal all round. A classic example today was the announcement of unemployment figures. For the government this is evidence of ‘the long term economic plan’ working , while for the opposition it’s further fuel to the ‘cost of living crisis’ fire. These trite clichés will be trotted out ad nauseam up to the election, and most of us will find it is off-putting to proper democratic debate.  Spin as opposed to proper evidence-based (or even deeply principle-based) policy offers.

Where are the parties’ narratives on society and on the role of civil society? How about social cohesion and community? I have yet to hear an election-focused speech from either Cameron or Miliband on these issues, let alone Clegg.

And whatever happened to the ‘Big Society’ – and what is Labour's alternative?

We need better. It’s no wonder so many people find that the political parties are not the place to find the answers to many of society’s problems and challenges. It’s why so many people now find outlets for their campaigning and advocacy work through charities, and why our memberships have soared whilst the parties have atrophied. Plenty of civil society groups – like the RSPB and National Trust, to name two of the biggest – have memberships in the millions, many times the size of all the political parties put together.

You can however be sure that ACEVO will be battling away on these issues, and challenging the parties to spell out their attitudes to society and community and the role of civil society. Isn't it sad that instead of spending proper time on all this we are having to battle away at the iniquities of the Gagging Act and the vague guidance on it from the Electoral Commission.

I suspect it will be down to charities to spell out the truths about immigration and climate change in the lead-up to the election, and to inform the debate on the environment and international development and build community and radicalism in public service reform. And you can be sure ACEVO won’t allow the Gagging Act to stop us pursuing our mission or on working with our CEOs to ensure we all continue to speak truth to power, whatever politicians might think about that. When the political parties fail to debate key issues then civil society must.

While I blog, it’s worth mentioning there is a good BBC Radio 4 programme on this topic tomorrow evening. Worth listening to – even the bits of me that they will use!

Oh my heart!

A fascinating few hours with the CEO of the British Heart Foundation on Monday, though it did make me think about whether I'm getting enough exercise (as he gently reminded me). I took a lovely leaflet from reception, “put your heart into walking" which is worth getting. And as I mentioned I do a lot of walking with the Hound.

I met for lunch with Simon Gillespie who has been a longstanding and valued member of ACEVO for many years (he was previously at the MS Society). This is one of the country’s biggest charities. Over 3000 staff and turnover above 200 million. It plays a vital role in the research that goes on into discovering the causes of heart problems and working on cures. Much of the advances in heart research has turned strokes and heart attacks into a long term condition as opposed to what carried you off into the next world is down to this wonderful charity. As I remarked to Simon, too often the NHS claims all this research as its own. In fact a third of all medical research is carried out or funded by charity.

They have great offices in Mornington Crescent, ironically in an old cigarette factory (a glorious Art Deco building). And as they have a big staff group over 2 massive floors they have their own cafe and outside balconies looking out over North London to the glories of Hampstead and Primrose Hill (but couldn't see Ed Miliband's house)! So lunch was at his office which is a change as most of my members don't have such a facility!

Simon has been in post less than 2 years but has been reviewing and revising their strategy, recently appointing new top directors. As the country understands better the importance of prevention and the care of people with long term conditions the work of charities like BHF become more important. There is also crucial work to do in how to reorganise the NHS to provide top quality care hospitals.  The reorganisation of London stroke services which moved to treating heart conditions in just 8 hospitals and not all 30+ London A+E showed the importance of rationalising cardiac services across the country. The idea that you need to be treated in your nearest A+E as opposed to the best centre for your condition is one of those myths we need to bust. And we need fewer hospitals and more resources in community and prevention.

And on health generally worth mentioning that all our Winterbourne deliberations are up on the NHS. England website; terms of reference, Membership and first meeting notes.  We agreed that we would make all our discussions accessible. So see them here.