The talk is of transformation and the mood is one of confusion and uncertainty. The rumour mills are producing a steady flow of an acid brew – difficult to swallow. Transformation and change was the message from Sir David and blogged under the heading “St David’s Missal’. Seven steps to a post-PCT world – it all seems so clear but as Andrew Craig wrote “Looking in from the outside, it is hard to imagine what the patients and the public will make of this diversity. How will they perceive the benefits of the new arrangements? If they don’t improve services and make it all feel close to patients, they won’t inspire either understanding or, much less, loyalty.”
But how much will patients be involved? The BMA seemed to be back-tracking on their earlier commitment within the space of a month. Patient representation is in danger of being relegated to a ‘nice to do’ thing whereas the White Paper treated it as central. Andrew thought there might be a danger of the BMA digging in to play its trade union role at the expense of the wider more inclusive approach that took in the whole spectrum of patient needs. Andrew wrote “The BMA, a trade union after all, asserts in its most recent commissioning guidance that “effective commissioning is effective general practice”. This is so wrong on so many counts: primary care is about so much more than general medical practice no matter how good it is and effective commissioning must stretch beyond health into addressing the wellbeing of a whole community.”
The frustrating thing for us is how little value many GPs appear to put on the rich resource that is the views and contributions of involved patients. Andrew’s blog on his evening with patient representatives in Wandsworth is a breath of fresh air. The closeness of the focus and the specificity of the issues is in contrast with all the hot air and pontification of much of the public debate about ‘Liberating’ the NHS. It is worth reproducing a large chunk of that blog:
Two themes stand out
Two themes during the discussion really stood out for me.
First, the overriding importance of real patient and public involvement in new arrangements – “No decision about me without me” is a hostage to fortune and the Government will be mercilessly pilloried if they abandon it or, worse, let the special interests water this down to mere lip service or box ticking.
Second, the central role of local authorities in leading on the things that matter to local people about health and well-being.
The question came up unprompted several times about why commissioning was to be divided between GP consortia and Councils. Would it not be more effective, people asked, to deal with Wandsworth as a single place with a single population and a common pot of resources and expert people working in a single agency to do the work across health and care?
The Go Go Gove Gov style
However the user involvement story is not one that is confined to health as Caroline’s blog on the energetic Mr Gove. The GO GO GOVE GOV style has little time for the views of others – no doubt in part for fear of delay and complication. The Secretary of State for Education gets a 0 out of 7 mark when rated by reference to the Consultation Code. Consulting or Commanding? asks Caroline, drawing on her own experience as a parent and school governor – recently elected to be Vice Chair of the Governors – she makes the point ‘nothing is guaranteed to create greater consternation at times of high anxiety than a perfunctory letter from the school and a “public meeting” called reluctantly at short notice where the powers that be fall into default passive aggressive mode and make it clear without quite saying so that they are simply waiting for the meeting to end so that you will get out of their hair and they can get on with what they or their bosses have already decided they are going to do.” Honesty is much the best policy – parents and children deserve better.
The Partnership Process – uniting the personal with the policy
The theme of ownership last treated in a blog on 1st September returns as a theme in Andrew’s last piece in September. It is he writes a theme that should not and will not go away. The issues becomes the clearer the smaller and the more local the State sector becomes. What will engagement look like in this new down-sized and delegated environment?
There will of course be casualties along the way and we regret that the AJTC should be top of the list of quangos to be culled. It is a small specialised body and its hit listed pre-eminence is purely alphabetical. Yet with Richard Thomas in charge with his vision of a truly user-oriented justice system, there was the potential for a transformative national project that would make sense of the jungle of institutions and processes that make up the legal system and seem at times to stand between the citizen and the resolution of his/her problems rather than facilitate them. Certainly Colin Adamson’s experience of one branch of the Tribunals service shows that there be dragons lurking in wait for the unrepresented first time user.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations.