Keeping an eye on the NHS Commissioning Board

The new Chair of the NHS Commissioning Board – Malcolm Grant Provost of University College London – is not unused to conflict. He has been attacked by the right and the left in recent times.

Now that he has taken responsibility for the governance of the NHS CB- worth at least £90bn of our money  – we need to quickly try to understand him.

Aside from the Government supporters of Grant include Aaron Porter – ex NUS President who fell from grace over his failure to organise assertive opposition to the student fee increases and Richard Horton Editor in Chief of the Lancet who defends his independence of mind and ability to drive through major change.

Critics on the left point out his poor record to inequalities. When he was challenged to introduce the London Living Wage for some of the lowest paid staff (cleaners) at University College London where he is the Provost he initially refused saying that to do so was a luxury that the university could not afford. It was only after a successful campaign by unions, students and the press that he did a U turn and agreed to do it – although a year later this has still to be fully implemented.

He earns in the region of £400,000 a year.

Earlier this month a general meeting of the University of London Student Union voted ‘no confidence’ in his leadership – in part this was in response to his perceived championing of outsourcing of public services and his willingness to fine and take student activists to court as well as his track record on low wages.

Health Select Committee

Its worth reading the pre-appointment hearing held by the health select committee held on the 18th of October 2011 which Grant attended. There is a lot in there – but one of weaker areas were his responses to how the NHSCB would be held to account.

As Rosie Cooper MP states (Q53) in response to an answer from Malcolm Grant:

“You will be accountable to the people via the press but not via structures. It is unbelievable”.

In his detailed answers to many questions I remain unclear how he believes the NHSCB will fulfil its independent role – and question and publicly challenge government policies if they feel that these are to the detriment of population health and wellbeing. For example he would not be drawn on commenting on cuts to Public Health Observatories (Q67).

Finally he describes the health and social care bill as ‘unintelligible’ and says that ‘he is not a patient of the NHS’.

So a mixed bag – he is clearly tough and used to conflict; willing to take unpopular positions and weak on accountability to the public……….and prefers to get his health care from the private sector.

Accountability in practice

2 months after the select committee we have the first ‘public’ meeting of NHS Commissioning Board – held on the 9th December. There is a rather poor quality video of the first 12 minutes or so.  From this we can deduce that this public meeting (There is some confusion as to whether this was a public meeting (website) or one held in public (Malcolm Grant) either way the public bit lasted just over 12 minutes – then the video ends abruptly.

This meeting was held in a video conference room in Quarry House – attended by 9 people (one of whom was joined virtually by video link)

They are not introduced – so I have no idea who most (9 white people, 7 men and 2 women – one of whom appears to be taking minutes) are. Aside from Bruce Keogh, Malcolm Grant and David Nicholson.

Some of the messages from Malcolm Grant were:

• Partnership working – CCGs, Patient Groups, Local Authorities the HEA and PHE
• Recognition of public support for NHS – almost doubled over the last 10 years.
• Need for greater attention to the public health agenda

At the time of writing the minutes of the meeting are not up yet. The next Public Meeting is scheduled for the 2nd of February 2012 and notice of it will appear 5 days before here.

At the earlier Select Committee he stated that he hoped his 5 non exec directors would be appointed by January 2012 – so we should expect to see them at this meeting.

So where does this leave us?

First, if you are a low paid manual worker in the NHS – I would not expect much sympathy from him.

Second, it feels a bit like the Italian experience – we seem to have a significant part of publicly funded service under the control of technocrats – with no clear accountability back to the public for their actions.

Third, the mechanisms that they have in place to communicate and involve feel….. amateurish. Who fancies going to the next ‘public’ meeting in February?