Sweep them all away! The destruction of local NHS Accountability
We are at a strange point of tension with a new prime minister coming in and trying to drive forward a devolution agenda at the same time as he inherits a health bill which is trying to destroy local public involvement and accountability in the health system.
The current Health Bill aims to abolish local Healthwatch and make it voluntary whether or not NHS Trusts choose to have a Council of Governors.
Council of Governors
Choosing to keep or get rid of councils of governors is of course not voluntary at all. This is because the Bill will take away all powers of existing Council of Governors which are as follows:
- representing members and the public;
- appointing the trust chair;
- appointing non-executive directors;
- holding the board to account;
- reviewing plans and major transactions.
These powers will either go up to the Secretary of State or disappear completely.
When I spoke to a Director in an Acute Trust they said that although he valued the contribution made by the Council of Governors – in a cash strapped world it would be hard to justify maintaining a council of Governors when they were asking for more funding from DHSC.
I think this is a specious argument – funding for Governors is very small beer.
If Council of Governors go that will be over 4,000 voices of carers, patients, workers, local politicians and the VCS that will be wiped out.
Local Healthwatch
I have made arguments about local Healthwatch being abolished before.
Just to highlight though – the sop being thrown out by DHSC civil servants is that the NHS Integrated Care Boards (who commission local NHS services) will pick up the local NHS Healthwatch role.
So much for an independent voice then!
Burnham Government and Devolution
In fact the Health Devolution Commission (founded by Andy Burnham and Co-Chaired by Oliver Coppard) has explicitly warned in the past that health reforms could produce greater centralisation unless the principles of devolution were embedded
At the same time as the Health Bill aims to destroy independent structures for public involvement locally; the Government is arguing that more decisions should be made locally!
Summary
The Health Bill reveals an unresolved tension at the heart of the Government’s devolution programme. It devolves responsibility and discretion to local NHS organisations while simultaneously removing statutory institutions that provide independent local voice and accountability.
Devolution therefore risks becoming administrative rather than democratic: local organisations receive greater freedom, but local citizens actually lose the little power over NHS organisations they currently have!
If devolution is intended to give communities greater control over the public services that affect them, why remove the statutory mechanisms through which those communities can independently hold local NHS organisations to account?
What we need
Yvette Cooper the new secretary of state for Health needs to ensure that the proposals to abolish local Healthwatch and make Councils of Governors voluntary for trusts need to be struck out of the bill.
What do you think?
Local Democracy and Health 
Hi Mark Thanks for continuing to press on this vital issue. The idea that an ICB can offer the same role as a local Healthwatch is so ludicrous that I can’t believe it is being offered as a serious suggestion. A significant value of Healthwatch is telling the local health system things it doesn’t want to hear, in a constructive spirit of partnership. An example from my Healthwatch days was around the creation of an elective surgery hub; a good idea in principle and for many people an excellent idea in practice. But the problems faced by people without their own transport were completely downplayed in the initial NHS consultation. It was one of the top topics when Healthwatch consulted on the issue, mainly I think because we were better at reaching the less-heard people. We also did some mystery shopping of real public transport journeys to the new site, and reported on the difficulties involved. I’ve met some skilled and effective people inside NHS involvement teams, but they can only work on the areas sanctioned by their managers, whereas Healthwatch could choose our own topics and timelines. Let’s hope that Yvette Cooper supports the amendments. Frances
Thank you for engaging Frances – helpful point re LHW and ICB
Hi Mark, I agree! It’s so important to make the distinction between local administration and democratic control.
How are you? I hear that you have been having a tough time healthwise. I hope that things are improving for you,
Very best wishes,
Judy (White)
Hi Judy – lovely to hear from you – am on hols now so will keep brief – I’m hopeful that now that Yvette is in charge we might see some of this nonsense in the bill expunged. As for my health – well I am in the ‘monitored’ phase – maybe I’ll be clearer in Oct for good or ill! You can see some of my learning about this in my recent ‘cancer’ blogs! All the best – hope you are in good shape – Mark