Over at The Guardian’s Comment Is Free website last week, Lib Dem minister of state for health Paul Burstow vigorously defended the Coalition’s health white paper, arguing it frames one overriding principle for the NHS – focusing on what people want, not what politicians prescribe. Here’s an excerpt:
Our consultation, Local democratic legitimacy in health, is a grand title for a simple question: how do we ensure the NHS better serves and accounts to the public for the money it spends and the results it achieves? In other words, how does the government’s localism agenda fit the NHS? …
Last year it took me five months to get the NHS to spell out how it had spent money on carers in my area – information that was vital for helping me to represent the interests of my constituents. I know I am not alone; across the country, the local NHS has lacked transparency and accountability for the choices it makes about services. This failure carries a huge price – anyone who suggests otherwise need only look at the history of Mid Staffordshire.
So the new NHS will be very different. We will pull back the curtains and shed light on all corners of the health service. Accountability will no longer only stretch upwards (rather obliquely) to Whitehall, but also outwards – clearly and tangibly – to communities.
Local authorities will take on a new role in making sure the NHS and GP consortiums listen to the public and are fully accountable for the money they spend locally. Councils will also regain control of public health for the first time in nearly four decades, and will help to fuse the strategy, planning and delivery of health, social care and wider public health services. This will be one system pulling together, not several pulling apart.
You can read Paul’s article in full here.
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4 Comments
This all seems good in theory, however it needs people who understand what is going on to make this work. In my opinion it is this working knowledge and understanding that has to be in place before this works that is the obstacle. I spend a lot of my time taliking to people and from my perspective this knowledge is not there.
democracy and citizenship relies on involving people in a meaningful way, without the knowledge or the motivation to acquire this knowledge this strategy will stumble.
Hmm – the proposals from Paul and Mr Lansley are the most radical shake up of the NHS in decades and have big risks, which I think we have to realise that we are taking. If it goes wrong it really could mean the end of the NHS in any meaningful way, so needs a lot of scrutiny.
I wish Paul didn’t give the example of Mid Staffs. This was (and still is) a Foundation Hospital (FT), whose reporting framework is much looser to PCTs than that of non foundation hospitals. FTs main monitoring body, Monitor, requires a lot less information than non FTs are obliged to give to PCTs.
As far as I understand the proposals, all hospitals will become FTs with looser reporting obligations to the new GP clusters than currently experienced between non FT hospitals and PCTs. Monitor and the Care Quality Commission will still exist and the only democratic accountability over hospitals in a significant way will be the current democratic joke that is governors of the FT, who are elected from a self selecting membership with massively low turnout. So public health and commissioning may have a bit more democratic scrutiny but these reforms in no way reduce the likelihood of another Mid Staffs disaster.
The original Lib Dem manifesto proposal was to make the PCT bureaucracy subject to local democratic oversight. That seems to make sense, if you are going to keep the PCTs. Bureaucrats are disinterested administrators, and if they are asked to take direction and guidance from a local authority, there is no obvious reason why they shouldn’t be prepared to do so.
But now we are going to replace the PCTs with GP commissioners, who are supposed to be responsible for doing the best job they can with the money they have, and will be competing with other teams of GPs to get the best results. Or we shall have private firms doing the commissioning on the GPs behalf, whose aim is to make a profit. What happens if the local authority tells the GPs and the private firms to do something they don’t want to do, which the GPs think is medically non-optimal, or which the private firms think is going to cut their profits? Won’t the GPs say that they must ignore what the local authority says, or else they will perform badly in competition with other GP consortia? Won’t the private firms simply insist on maximising profit?
What happens when it all goes wrong? Won’t there be an obvious blame-passing route, whereby the GPs can say the local authority messed things about, and the local authority can say the GPs failed to listen to them, and mistakes will end up being covered up?
Privatised industries don’t normally have local authorities to look after the public interest. They have organisations such as Ofgen which are put in place to regulate their markets. How well these regulators work is a different issue, but at least they are structured to deal with a competitive market situation.
The truth surely is that the Lib Dem proposals don’t fit any more, now we are going for a competitive market NHS. The Lib Dems have been allowed to bring them in simply as a pretence that they are still influencing important aspects of coalition policy.
I followed the link and started to look at the document. Then I thought – what’s the point?