Right Issues – Wrong Actions? Fit for the Future 10 year Health Plan for England

At the centre of the government’s Fit for the Future (FFF)is a loss of heart – replaced by an inward looking managerialist response to complex challenges.  The NHS is ours. We need governments to enable citizens to engage with services, to work alongside, to actively discuss and challenge.

The plan recognises the importance of addressing quality and pays lip service to the primacy of place. Yet it fails to understand what actions are needed to drive improvement and empower services to improve.

The FFF rightly highlights the litany of terrible high profile failures such as Mid Staffordshire, East Kent Hospitals, etc (p86).

It goes on to say that it is essential to put patient choice, voice and feedback at the heart of how we define and measure quality.

Yet … it shows no understanding of the important role played by organised collectives of the public to get many of these issues heard. From Grenfell through to Windrush, Infected Blood Scandal etc. The people who were affected and their supporters came together to campaign, whistleblow and challenge. These campaigns should not have been needed – but were an important and necessary contribution to highlighting serious deficits in the system. 

The reality is that complex democratic systems will always require external challenge led by the public. There is a delusion that the solution is only about being better managers … over a system where we will never be in complete control, we need to celebrate this public challenge and make it easier for it to happen. 

Local places need to be able to provide a locus for this external, public led challenge.

This is why it is so foolish to propose getting rid of Local Healthwatch.

The 10 Year Plan instead focusses on the primacy of individual experience over collective action.

• We see a slashing of any intervention that brings the independent voice of the public to challenge the NHS from the outside – such as local Healthwatch. At their best local Healthwatch are important partners to functions such as the Local Health Overview and Scrutiny Committee and through their actions they have empowered NHS staff who lack the confidence to speak up on issues they know need addressing.
• There is an incorrect and naive assumption that ‘moving this tiny function inside the NHS will somehow retain it. (P89) Get real – taking a couple of staff who work in a specialist organisation focussed on public challenge and putting them in an organisation where this activity is marginal to their day to day – will not work. For goodness sake (as FFF notes) they have enough difficulty accommodating internal whistle blowers!
• Separation of the residual local Healthwatch resource into local government social care and the NHS ICB which fails to recognise just how integrated these services are in terms of many peoples experience (eg older, people with disabilities etc)
• A weakening of the public voice on Foundation Trusts – saying that it is not compulsory for NHS Trusts to have public governors anymore – p81
• The proposal to trial “Patient Power Payments” (p83), feels like more soundbite nonsense. A belief that improvement can be driven through allowing patients to decide if they are happy with a service by having the power to determine whether or not  the final cost of a service can be paid over to the relevant provider. How is this going to work exactly? Patients paying over the ‘tip’ for surgery? GP appointments? A prescription letter? The effectiveness of Statins? The chat with the GP? Who will do the admin?
• The reliance on the holy grail of a single NHS App – one app to rule them all! Which will allow patients to refer themselves for some treatments, choose providers, leave feedback. There is no recognition of the digital deficits faced by many people which will widen the inequalities gap.
• There is no humility – how about learning from (and collaborating with?) exemplary independent  providers such as Care Opinion who magically bring together qualitative and quantitative public experience of social and health care services and engage providers in these stories.

At the core of FFF is a loss of heart – replaced by poor quality analysis which does not appear to know what drives change. The NHS is ours. We need governments to enable citizens to engage with services, to work alongside, to actively discuss and challenge.

Instead we see poor quality technocratic solutions put forward which individualise peoples experiences and a massacre of independent public voice organisations which could help us to come together, share our experiences and our ideas and contribute to positive change.

What do you think?

For some of the background to this see – my blog on Healthwatch England from last year