Throwing snowballs at moving trucks

Looking for enlightenment from those putting the new commissioning system in place about how accountability to patients and the public will work?  So are we, but none was forthcoming at the recent session of the Health Select Committee quizzing DH mandarins David Nicholson, Barbara Hakin, David Colin-Thome and Ben Dyson.  What sounded like evasion on the accountability point turned out to be an admission that they hadn’t got to that point in their thinking yet (but rest assured they would soon).  It would all be in the constitution of each consortium, they assured the Committee.  And the NHS Commissioning Board would hold consortia to account for it.  But what would “it” be wondered some of the committee members if consortia were being asked to work out their own constitution and not follow a national model?

We’ve excerpted some of the thrust and parry around the accountability question below.  Be assured that no witnesses or MPs were harmed in the fancy bladework involved in making this post.

Consortium “boards” meet in public?

Rosie Cooper (Lab-West Lancs)  made a quick thrust:   This White Paper is huge on autonomy and very, very poor on actual accountability. Will the consortia boards be (a) open to attendance by members of the public and (b) will there be non-executive directors on it?

Dame Barbara Hakin, National Managing Director of Commissioning Development, parried in response: In terms of the accountability and the public, I suppose a bit depends on whether you really see accountability and responsibility to patients and the public as being discharged simply through a board. You are right, and Ben made it very clear, that for the moment the consortia will have to have a constitution. They will have to be authorised. They will have to meet the principles of good governance. For their authorisation, they will have to demonstrate how they are properly accountable and how they are properly involving people in shaping their opinion, which are two different things.

“NEDS” on the commissioning boards?

Sir David Nicholson, Chief Executive of the National Health Service, redoubled the attack: The individual consortia are accountable to the National Commissioning Board. It is very clear. They are not accountable to anybody else.

Rosie Cooper riposted:  The whole basis of this change was set out by the Secretary of State to be based on transparency, openness and accountability to the public. People will be able to make real choice and be really involved. You have not described anything at the core where the power is being held. You haven’t described anything which shows that real people have any real access with training and ability to challenge at the level at which it will be required

Nicholson stood his ground: That is exactly what the local authority will be doing. The local authority will have the oversight of the commissioning process overall. It will have the power of the Joint Needs Assessment. It will have the public health budget. It will have access to all of those things in a way it has never had before.

Barbara Hakin created a diversion with HealthWatch:  I do think that there are many other ways that we can involve patients and the public much, much more in what we do, in how we make decisions about health and in how we understand what they want than a small number of non-executives sitting on a board, and that is something that we will clearly have to build through HealthWatch.

It’s all about power

Fiona Mactaggart (Lab-Slough) threw down the “p word” gauntlet: There is an issue here about power, and I think my anxiety about the White Paper is that it assumes that power exists without giving people the equipment which enables them to be powerful. I am particularly concerned about this because I represent patients who disempower themselves, whose view is that it is the doctor’s problem when they are ill, not theirs, and who find taking responsibility for their own wellbeing very hard.

And Cooper gave the witnesses a good slap with it too: Disappointingly for me, I have not heard anything that makes me feel more comfortable in terms of accountability and real patient-centred care-patients at the very core of this. I just have not heard it because the actual power is going further up into boards where the ordinary member of the public will have less and less influence, and I don’t buy for one minute that a Wellbeing Board is actually going to exert any influence over a consortia grouping which will, in all probability, meet in private and may or may not have non-execs on it. I have not heard one noise from any of the panel to tell me I am wrong.

Throwing snowballs at moving trucks

On the basis of this outing in front of the Committee, we’d have to say the mandarins were on the defensive and that the big accountability questions remain moot.  Rosie Cooper’s language was more colourful.  She used the rapier: “It is just like throwing snowballs at a moving truck. It is not going to have any impact whatsoever.” They do have a way with words in West Lancs.

The Moore Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations

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