Friday, June 23, 2006

Democracy in the NHS

The book The Future of the NHS edited by Dr Michelle Tempest is now out and available on amazon, having had the launch party on Wednesday evening. At the same time as the launch there was a poll carried out by You Gov which showed a two to one majority in favour of the government withdrawing from the NHS. This poll highlights one of the major challenges for the NHS in the years to come: reducing the democratic deficit which Daniel Hannan MEP and I wrote about in the book. The following represents a summary of that which also appeared at on 28 June 2006.

As we celebrate the 60th anniversary of the passing of the original legislation for the NHS and the institution stumbles from one crisis to another, a timely poll has been carried out by YouGov which shows a two to one majority in favour of the government withdrawing from the NHS. This poll highlights one of the major challenges for the NHS in the years to come: reducing the democratic deficit.

Unfortunately, the only elected representatives so far introduced into the NHS have been to foundation hospitals which would seem to be a case of putting the cart before the horse. It is the commissioners in the primary care trusts (PCTs) rather than the providers of health care that most need accountability if local people are truly to be empowered. They make the decisions as to what resources are given to primary care and in what form and also what resources are allocated to secondary care such as hospitals. The major difficulty with these bodies is that they contain no directly elected representatives. Further, there is nothing to stop its current membership of, for example, GPs, simply allocating resources in a way that suits themselves without sufficient reference to the local needs of patients and of hospitals and other services.
Given the significance of the decisions which the trusts make in terms of resource allocation, we suggest that PCTs should be abolished in their present form and replaced by an independent Commissioning Body consisting of directly elected representatives. These would be under a duty to consult all stakeholders as to how resources should be allocated. These would include GPs, hospital and community doctors, private sector providers of health care and patients. National targets and centralised decision making could then be left behind in favour of local people being trusted to make the decisions that most suit their own communities thus invigorating community involvement in health care.

Alongside this, we also suggest that the whole structure of the NHS needs to be revisited and simplified down to as few layers as possible. It would be hoped that primary care trusts and other health organisations could be given boundaries that coincide not only with each other but also with local authorities. This would facilitate the provision of directly elected representatives in that the new commissioning bodies could then consist of locally elected councillors. With this democratic safeguard, there is no reason why decisions which are currently made centrally should not be made at the more local level of the new commissioning body. This could include, for example, decisions as to which drugs to make available with the National Institute of Clinical Excellence simply taking an advisory role. Further, national targets could be abolished in favour of this devolution of power.

The You Gov poll is therefore a timely reminder that the NHS is in need of invigorating and entrusting back to the people it serves in order that a new flame of civic pride will be lit which will guide the institution through its next sixty years.

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