We have a plan – a 10 point plan focusing on Public Accountability and Patient Engagement in the Health and Social Care Bill. Listening to the Prime Minister this morning on the Today programme, he talked about the label of “GP commissioning” as being misleading – echoing a sentiment he expressed at the meeting in Number 10 to discuss the shiny, new NHS Future Forum, according to our well-placed source in No 10. He said more clarity was needed. So we are responding to the call for clarity with the MAC plan and making use of the pause to advance some radical new ideas. It’s MAC’s gift to the Future Forum and, we hope, the future of the NHS in England.
- No to Health and Wellbeing Boards
- GPs have to show they serve their own patients well before becoming involved in Commissioning
- Proven Patient Responsiveness makes more money available to Commissioners
- All meetings open to the public and subject to freedom of information law
It’s not all about councillors
A big theme that is coming out of the re-organisation discussion is the importance of local Councils and their elected members. The new localism means more say for Councils. Local government has the structures and the processes to organise service delivery locally for example to respond to the needs of a growing segment of the population – such as elderly people with complex health and social care needs. They also claim that their planning and consultative forums as have grown up around process such as the JSNA and are therefore output oriented. Plus (they would go on to say) the traditional role of the elected members has always been about user participation and representation. Therefore they are well-placed to deliver the user-oriented outcomes more effectively than newer and more fragile and transitory arrangements bolted on to the health services to represent patients.
MAC says ‘Yes, but up to a point’ – for we remember the days of consumer representation when places on local consumer representative bodies appointed to oversee, for example, the quality of local postal services were filled with local government appointees whose perfunctory participation did nothing for the user. And our memory of CHCs pre their ham-fisted abolition in 2003 has lots of examples of places for elected local councillors going unfilled or treated very casually.
Citizen and consumer interests
One of our principal contributions to clarity in this long-running debate is to distinguish between forms of representation – the question of the difference between citizen and consumer.
We see the citizen as the ‘moral owner’ of the Health Service (and all public services) and we also see the structures and functions of representative democracy at local and central level as the mechanisms to discharge the duties and obligations of that ownership.
In contrast, the consumer interest is that of the users of the services provided and here we can draw upon the whole range of tools and methods to gather and advocate the patient and user views that are generally lumped together under the patient engagement banner.
Caroline Millar made this point in our February evidence and submission to the Health Committee.
The NHS Constitution says that the NHS belongs to the public but fails to elaborate on what this ownership means in practice. The fundamental confusion about what accountability means in relation to the health service is reflected in the Bill and as a result GP consortia stand to be pulled in numerous different directions by the National Commissioning Board, the local Health and Wellbeing Board, possible Overview and Scrutiny and (lest we forget) the patients and the public…
The Bill fails to make a clearer distinction between the accountability of a clinician to a patient and the accountability of the NHS to the public. Although inter-related, they are not the same thing and people will respond differently depending which role they are fulfilling.
It is this latter relationship that may well lie within the preserve of local government and its elected members. The relationship between doctor and patient is best expressed through the patient engagement techniques that monitor the patient experience and use it to make improvements.
Pulling plums from a politicised pie
We wish the NHS Future Forum well in their difficult job of pulling some decent plums out of what is now a very politicised pie. And please do not forget the depleted corps of the much-abused NHS managers who are trying to make sense of the service reconfigurations under the QIPP label. They are to be pardoned if they feel that their only reward for making the difficult decisions to decommission – shut down – a service, is to be immediately disavowed by the politicians who suddenly are faced with the consequences of a process they set in motion. Big topic and one for another time.
The Moore Adamson Craig Partnership supports user and public participation, trains lay representatives and develops responsive health, care and education organisations. We are ready to work with and support all those who want to make sense and a success of the new structures of patient and public engagement within the new arrangements for health and social care commissioning and providing. Feel free to contact us to discuss the opportunities.