On 15 October I published a short essay about participation. Since then Wes Streeting has launched a consultation into the NHS.
In the 1970's I served as a councillor. The council could make appointments to the local and regional hospital trusts. Of course the objection is that these were party hacks but in practice they could also be well intentioned public service minded people. When the Labour party was in control this often extended to TU delegates. Very far form perfect but, in theory at least, through the local democratic process there was a mechanism by which lay participation on the management of the health service was possible.I do not propose a return to this old system. But we do need to replace it with something that puts citizens in the loop.
Here is why; It is our service, as citizens we have both a right and a duty to make sure it works and delivers for us - this is not a party political issue.
The NHS is just too big and complex for ministerial oversight be effective. Ministers in any case are party political and drive change without a majority in the voting population when they have a majority of seats in parliament. The NHS Exec was put at arms length from government - to stop direct ministerial interference BUT as a result ends up much like a quango; the key question being who is appointed to it, and what their loyalties are. The workings are opaque - unless you do a lot of digging.
At the lower levels of management medical expertise has become secondary e.g. a surgeon I know will say that's a big op so we can only do that and three more, the manager will say we are scheduling 5. It is the surgeon who has to explain to the 5th patient who cannot be fitted in that their operation will not take place.
If outsourcing is used for specific services in addition to the problems I discussed earlier the organisations used will be commercial, not democratic and no doubt the contract details will be commercially sensitive. The mechanisms I propose will make sure that the outcomes are being monitored by the people they matter to and not just looked at as contract fulfilment.
What I propose.
Whatever management structure is adopted, provision will be made for staff and public (citizen/patient) input to and oversight of the management and delivery of the NHS. There are many ways this could work.
Here are my initial thoughts.
The representation should be organised in the form of supervisory boards (i.e the executive body plus the local patient/citizen reps). The meeting maybe bimonthly and would be run by a trained facilitator. The body would be briefed on all management decisions and have power to call and review anything contentious; like a second chamber - review and rethink not veto.
Staff could make up 1/4, the actual executive 1/4 those with some expertise 1/4 and those merely interested 1/4.
Interested people register their interest and willingness to participate. The executive (i.e exiting management) would send the Chair, Chief Exec and whoever else. Sortition (random selection) should he used to select from each of the other 3 sub groups. The size of the board between 12-24 (i.e. 3-5 from the 4 groups)
The body would get a full set of operational metrics including but not limited to; medical outcomes, waiting times, patient satisfaction, incidence of illness by catchment, and budget allocation. A key requirement would be to see that metrics were showing an improving trend.
If the organisation has local, area, regional and national tiers the supervisory board should be set up in parallel.
The executive would have a duty to consult the supervisory board before any major decisions.