NHS England’s “Call to Action” seeks clarity but adds confusion

act nowBack in July NHS England launched “A Call to Action.” Emblazoned on its digital cover were the words: “The NHS Belongs to the People”. Inside was the stern warning “If the NHS is to survive another 65 years, it must change” signed by ten of the great and good from English health and care. It was stirring, if depressingly familiar, stuff. 

Since then, “calls to action” are becoming a fashion statement. No sooner had the July “call” appeared that we had another one in the dog days of August calling us to action for our views on the future of general practice. Will there be one for social care next?
In the retail world a “call to action” invites consumers to respond with “click here, do this, buy now” behaviour. It’s quick and focused. NHS England’s “calls” are rather different. They want our considered views on things that most people don’t think about very often if at all.

Can’t answer the call 

I don’t see many people taking to the streets to attend meetings or tapping away on social media platforms with their responses about what needs to happen to make the NHS better. We are told not to worry, because the CCGs will be undertaking public engagement events on the “Call” in September. All we have to do is contact our local CCG and ask what’s happening.

While waiting for my local CCG to get its engagement act together (could be a long wait), I’ve been through the “Call” and found it raised a question that must be answered before anyone can give a view about how we can “fix” what’s wrong with the NHS in England. Here’s the killer question: “what is a core service”? It is a novel question for the NHS.

Why “core” is a killer concept

The “Call” says “core NHS services” will be “protected” and “free at the point of need for everyone”. But the problem is that these services are not defined anywhere. It is noble to declare “we will not contemplate cutting or charging for core NHS services”. But the public must be clear what these are. And we’re not.

The “Call” uses confused terminology: it describes these services as “core”(p 6) and also as “fundamental” (p 23). Are these the same thing? Who knows?

If the NHS offers “core” services, then logic says some things in the total NHS offer may not be “core”. We don’t know what these might be, of course, but if they exist then in future it might be that non-core services could be charged for. This possibility is ignored by the “Call”, even though its use of “core services” as a concept raises the very question of what might be “non-core” services and leaves open how they could be paid for.

The “Call” makes itself a hostage to fortune by stating “We firmly believe that fundamentally reducing the scope of services the NHS offers would be unconstitutional, contravene the values that underpin the NHS and – most importantly – harm the interests of patients.” You can see how this could turn into a field day for local challenges and judicial reviews.

It can happen with Foundation Trusts 

Take the analogy of Foundation Trust authorisation. Monitor approves the services which the FT will offer as a condition of the licence. But they may offer other services outside of that. An FT which found that some of these services were not economic could discontinue them and still not breach the terms of its authorisation because its core services had not been affected. That principle comes into play any time there is talk of “core services” – and that is the confusion introduced by the “Call to Action”.

The owners must decide the ends of the NHS

All of this goes to show why we the public, the “owners” of the NHS, need to be clear about what is “core” and “protected” and what might not be. We can’t really respond to any calls to action until that is resolved. Where will the answer come from? In truth, it can only come from us, the public. Until there is a national consensus about what the NHS in England is for – what its “ends” are – we cannot decide what services it should offer, much less the means to fund them with a sustainable slice of the public revenues. That is the “call to action” the citizens of England should really be responding to.


The Millar Adamson Craig Partnership supports user and public participation,  trains lay representatives and develops responsive  health, care and education organisations.  Feel free to contact us to discuss the opportunities.  Follow MAC on Twitter @publicinvolve


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