The need for democratic accountability at a local level in the Health Service
- The word from on high. Labour has its hands on too many levers.
Guardian leader, March 30, 2000
Power to the patients.
Revolutionising the NHS: Will Hutton advocates health board elections, while a poll shows a clamour for reform. Guardian 18 April 2000
Ministers should 'let go control of NHS'. The future of the NHS: special report Guardian, 18 April 2000
Remote and unresponsive, The future of the NHS: special report. Guardian, 18 April 2000
Council holds confidence poll on NHS leaders. . Guardian, 11 May 2000
Local democracy
Sir Peter Kemp, former Whitehall mandarin, submits our wishlist for local democracy to a reality
check.
Guardian 3 August 2000.
Seventeen months after primary care groups (PCGs) were introduced to improve local health services, they are still struggling to come to terms with their mandate to get the general public on board. Ministers have warned them that patients and other NHS users will no longer tolerate a paternalistic health service that pays lip service to public involvement.
The message is clear: PCGs (which are responsible for buying health services for the area they represent) not only have to make sure that local communities are consulted before decisions are made, but that they are involved. The same goes for primary care trusts (PCTs), introduced in April this year, which are similar to PCGs, but have the power to provide services for their local residents, as well as buy them from other agencies (such as the local hospital).
But the reality is that public involvement is still a long-term goal for most PCGs and PCTs. According to a recent study by the King's Fund, the independent health policy institute, it comes way down the list of priorities of most chief executives. The report says: "Their energies are focused on infrastructure, finance, developing primary care and clinical
governance."
Guardian 30 August 2000.
Patients claim priority
People are ever more ready to challenge medical decisions
It is a given that people are becoming increasingly consumerist in their attitude towards public services. But a report today shows just how fast that change is
happening.
Guardian 13 September 2000
Scotland's new first minister, Henry McLeish, is considering footing the bill for long-term care of the elderly north of the border, raising the prospect of a fresh divide between Holyrood and Westminster. Guardian 6 November 2000.
Pensioners throughout Britain will rightly see the Scottish parliament's decision to introduce free personal care to all pensioners north of the border as a victory for justice, equality and compassion (Rebels force u-turn on care for elderly, January 26).
Guardian letter from Jack Jones, 27 January 2001.
Devolution is drawing an indelible line across the UK. On one side students pay tuition fees, the teaching profession is in crisis, and many of the frail and elderly must pay to help meet the costs of their care. On the other there are no tuition fees, teachers have won a 21.5% pay deal, and now it looks as though all pensioners will enjoy free long-term care.
Guardian, 27 January 2001.
The Scottish executive has embarked on a collision course with Westminster after a parliamentary rebellion forced the first minister, Henry McLeish, to offer free long-term care for all Scotland's pensioners.
Minutes before a vote on the issue in the Scottish parliament yesterday, the executive announced a dramatic policy u-turn and said it would implement plans to fund long-term care for all pensioners.
Scottish pensioners will now get free personal care, including bathing, changing dressings and assistance with eating - services that pensioners in England and Wales will continue to pay for.
Guardian, 27 January 2001.
Community leadership: the basics
Simon Parker. Councils have led their communities for years, but with the decline in the number of services delivered directly by local government, their role has become increasingly more important. At its most basic, community leadership is about finding innovative solutions to the problems faced by local people, and acting as their representative with central government and its quangos. Labour ministers, and many councillors and officers, accept that this will be local government's future job. There is, however, still a great deal of confusion about what it will mean in practice. The government hopes councils will develop individual definitions to suit local needs. Ministers have given local government a number of new freedoms and responsibilities to help fulfil this role. The most important is a power that allows councils to do anything not prohibited by law in the name of improving the social, economic and environmental wellbeing of their communities. New powers for local government to scrutinise the health service are also being seen as part of the community leadership agenda. Supporters argue that these will allow councillors to make the voices of local people more forcefully heard in a highly undemocratic NHS. Guardian Society Wednesday March 21, 2001
Getting rid of community health councils (CHCs) as outlined in the NHS plan has proved tougher than ministers might have thought. Guardian Society Wednesday March 21, 2001
After local council success of Health Concern campaigners, a retired consultant sets his sights on parliament.
Jeevan Vasagar.
Richard Taylor spent 23 years working at Kidderminster hospital in Hereford and Worcester. Now he paces its grounds pointing at buildings that are being gutted or mothballed. Guardian Unlimited
Monday March 26, 2001
Local authorities are claiming a victory in their bid to stop the NHS taking over community services, following government concessions on care trust proposals. Guardian Society
Thursday April 5, 2001
Greater centralisation is necessary if we want to avoid a postcode lottery for public services. But, asks Tony Travers, is it a price we are prepared to pay? Guardian Society
Wednesday April 11, 2001
Plaid Cymru wants more regulation of the health service to be devolved to Wales. The party would also allocate spending on grounds of need rather than population
Guardian Society
Tuesday May 8, 2001
Labour's David Lock yesterday became the government minister most at risk of losing his seat after the Liberal Democrats backed an independent standing on an NHS protest platform in Mr Lock's volatile Wyre Forest constituency.
Kidderminster Health Concern's candidate Richard Taylor, a retired consultant, has enjoyed a groundswell of support for his campaign against the downgrading of Kidderminster hospital's
facilities and his party already holds the balance of power on Wyre Forest district council. Guardian Society
Thursday May 17, 2001
I was standing behind Sharron Storer when she told Tony Blair about the neglect of her sick partner in a National Health Service at the end of its tether. What was striking wasn't her anger or the sound of nurses cheering her on, but the Prime Minister's face. It was the face of an actor paralysed by stage fright. Storer wasn't in his script.
Observer
Sunday May 20, 2001
GPs back woman who berated Blair
Guardian
Monday May 21, 2001
Now GPs join in the Birmingham hospital protest
Guardian Letters
Monday May 21, 2001
The author, a retired consultant, is contesting the Labour-held marginal of Wyre Forest in Worcestershire as one of a local group protesting at hospital cuts.
Richard Taylor
Guardian
Tuesday May 22, 2001
Dr Richard Taylor (rtd) is standing for the Independent Kidderminster Hospital and Health Concern party. Astonishingly, he might win, defeating David Lock, a government minister. Martin Bell thinks he will win, and is coming to speak for him. Whatever happens, Dr Taylor will hugely influence the result, and thus scare all the mainstream parties.
Guardian
Wednesday May 23, 2001
Ex-doctor offers voice of honesty
Guardian
Saturday June 9, 2001
The low voter turnout mars the very basis of Labour's electoral mandate (Blair cruises to victory, June 8). Guardian Letters Saturday June 9, 2001
For many, it was a tough decision between two unpalatable choices. But, in the knowledge that things could not get any worse and the hope that things really would get better, they voted for the lesser of two evils. Guardian
Monday June 11, 2001
OK, we'll vote for you. But we haven't forgotten all this...
Guardian Unlimited
Tuesday June 12, 2001
Break the whip
MPs should have their salaries pegged - and be free to vote as their consciences dictate
George Monbiot
Guardian
Tuesday June 12, 2001
MPs return to the House of Commons in a new mood. If Tony Blair was sombre in victory, so are they. Three weeks' door knocking was a sharp reminder of uncomfortable things out there. In their weekly surgeries they see plenty of trouble, anger and grief: they all have Sharron Storer moments - so much to be done, delivery or death. Polly Toynbee
Guardian
Wednesday June 13, 2001
Time to chop the payroll vote
Letters from Sheila Porter-Williams and others. Guardian
Friday June 15, 2001
Real accountability must make a return to local democracy if the government wishes to boost turnout in elections, says Dennis Reed
Guardian Society Friday June 15, 2001
Blair has the freedom to do what he likes - at a price
In this second term, we'll know just who to blame if things go wrong
Hugo Young
Guardian
Thursday June 21, 2001
Everybody agrees that the NHS needs change. But after the shock election
result in Kidderminster, it's clear that there is still a huge gulf between
government and public. Patrick Butler reports. Guardian,
Wednesday July 4, 2001
The lesson from Europe is that the way to improve public services is to hand
them over to local government. Nick
Clegg Guardian Monday July 23, 2001
'It is an opportunity to achieve greater accountability and openness in the
NHS'. Long fight for truth about blunders. Guardian
Friday January 18, 2002
Local authorities should be given the lead role in combating health
inequalities to prevent public health measures slipping off the NHS agenda, a
council-backed pressure group has urged. Guardian
Society Friday March 8, 2002
People want say in local services. Residents want to pick police chief
and NHS chairman. Patrick Wintour Guardian
Monday April 29, 2002
The government wants local authorities to justify large rises in council tax
by holding referendums. Where the case is made, they can be won. Simon
Parker Tuesday
June 25, 2002 The Guardian
Good views. Simon Parker rightly points to the wider use of referendums by
local authorities in allowing people a greater say (Vote
now, pay later, June 25). It is wrong to limit referendums to the running
and funding of services. If the biggest issue is the health service or
transport, then councils should be able to elicit local views via a referendum
on issues such as these too. If such a referendum was linked to the local
election, it might attract a greater number of voters. Dennis Reed -
Commission on local governance. Letter Wednesday June 26, 2002 The
Guardian
The Liberal Democrat leader, Charles Kennedy, today said that he was
considering plans to give local councillors control of the NHS and fund the
health service through a special dedicated tax. Society
Thursday July 4, 2002
The Liberal Democrat leader, Charles Kennedy, yesterday moved to reposition
his party as the one most committed to delivery of public services, through
decentralisation, mutualism, and earmarked taxes for health. The
Guardian Friday July 12, 2002
The
full text of Charles Kennedy's speech
A new battleground in British politics is set to be opened when the Liberal
Democrats propose a big programme of decentralisation, shifting power from
Whitehall and handing tax-raising powers to local and regional
government. Patrick Wintour, chief political correspondent Guardian
Wednesday July 31, 2002
Two interlocking policy issues will dominate the run-up to the next general
election. Issue number one is familiar: improved provision of education,
health and other services. Issue number two is moving rapidly into the frame:
the extent to which services should be controlled at local level. Leader
Guardian Wednesday July 31, 2002
The Liberal Democrats yesterday promised sweeping reforms to make the NHS
more accountable to local people. Michael White, political editor
Tuesday September 17, 2002 The Guardian
The path to empowerment. A consensus is emerging on the need to
decentralise public services, but where should the power go? Nicholas Boles
examines the options.
Guardian Monday October 7, 2002
Elite institutions show the way. John Carvel
Thursday
October 10, 2002 The Guardian
Chancellor unveils new vision for local services. Simon Parker
Society Friday October 11, 2002
The government is again trumpeting its more autonomy for councils policy,
but it will need more than reannouncements to keep ahead of the freedoms for
public services fad, writes Simon Parker. Society
Friday October 11, 2002
'New localism' seen as key to providing public services. Patrick
Wintour, chief political correspondent
Saturday October 12, 2002 The Guardian
Local government must retain control of social care if it is to provide
community leadership and promote wellbeing, the new president of the Association
of Directors of Social Services (ADSS) said today. David Batty
Friday October 18, 2002
Tony Blair's ambitious plans to reform Britain's public services will fail
unless local people are given real powers to run their schools and hospitals, a
leading think tank argues today. Nicholas Watt, political correspondent
Friday
December 27, 2002 The Guardian
War of words over how to free public services. Debate runs across
cabinet on the best ways forward for health and education. Patrick
Wintour, chief political correspondent
Friday March 7, 2003 The Guardian
Democracy and markets in the NHS. Letters
Monday
March 24, 2003 The Guardian
The health secretary, Alan Milburn, holds out the prospect of a new era of
democracy in the health service today, with the possibility of new primary care
trusts - PCTs - being elected in a few years' time.
Wednesday March 26, 2003 The Guardian
Local authorities could take over health service commissioning from the NHS,
a thinktank suggests today. Tash Shifrin
Friday November 14, 2003 .The proposal comes from the Democratic Health
Network.
Ignoring local government altogether won't solve its problems, writes Dan
Corry.
Wednesday January 21, 2004 The Guardian
The government should bring citizens "inside the decision-making tent" of
local public service delivery and relinquish the "commanding heights of the
state", former health secretary Alan Milburn said today. Hélène Mulholland
Tuesday March 2, 2004
A national consultation on how to improve public health and tackle the
"worrying problems" of obesity, smoking and sexually transmitted infections
has been launched by the health secretary, John Reid. Tash Shifrin
Wednesday March 3, 2004
The NHS is wasting £8.4bn a year by not involving patients and the public
more in managing their own care, a report claimed today. Thinktank the New
Economics Foundation (Nef) said current health policies failed to grasp the
potential for increasing the involvement of patients and frontline staff.
Hélène Mulholland and agencies
Wednesday March 10, 2004
Public sector boards face new code of conduct. Matt Weaver
Tuesday January 11, 2005
Labour wants to give people more control over services. But what, asks
David Walker, will this enthusiasm for public participation mean for local
councils?
Wednesday January 12, 2005 The Guardian
Doing the right thing - for a change. Simon Caulkin on why changemakers
who work from the top down are doomed to fail.
Sunday October 16, 2005 The Observer
Keep it together. Too many cooks needn't spoil the broth, says Julie
Jones.
Wednesday October 26, 2005 The Guardian
The NHS needs localisation, not regulated privatisation. Yet another
restructuring of healthcare will waste more billions if it is based on choice
rather than local service and control. Simon Jenkins
Wednesday
December 14, 2005 The Guardian
Devolving power closer to people is trendy today, but localism isn't fair,
equal or consistent. Peter Preston
Monday
January 23, 2006 The Guardian
MP in call to
transfer hospital. North Shropshire MP Owen Paterson is calling for under
threat Whitchurch community hospital to be handed over to Shropshire Council,
rather than closed. He says the council could run the hospital more
efficiently by integrating it with social services.
Summary by Keep our NHS Public
of
Shropshire Star 23 January 2005
Health alert:
infectious ideas. Libby Purves argues that where services are threatened,
as in Suffolk, communities should be allowed to put innovative ideas into
practice, such as buying a hospital and continuing to run it as a social
enterprise.
Summary by Keep our NHS Public
of
Times 24 January 2005
PCT
accountability drive. Patricia Hewitt has said that the forthcoming white
paper will call for PCTs to be made accountable to local populations. Hewitt
told a meeting of MPs, union leaders, and NHS and voluntary sector
representatives that accountability of commissioners for the services they
purchase is "critical". But a policy source said that while the white paper
will call for accountability, "there won't be much on how". Hewitt may have in
mind the suggestion by Paul Corrigan, Blair's health adviser, to "bypass all
forms of intermediary and allow groups of patients to self organise and
petition their PCTs directly, with the PCT obliged to respond to a petition by
having to invite more primary care providers to come to a location".
Summary by
Keep our NHS Public
of Health Service Journal 26 January 2006
London councils
'should run primary care'. A review by the Commission on London Governance
has said that London councils should take over the functions of PCTs. The
commission, made up of politicians from the London Assembly and the
Association of London Government, said giving borough councils commissioning
powers over GP services would streamline health and social services and would
help to reverse the general trend power being held by central government
agencies and quangos over which Londoners have no direct control.
Summary by
Keep our NHS Public
of
Public Finance 17 February 2006
An NHS for the
people. A Mirror editorial says: "Democratic control of the NHS means a
vital public service funded by taxpayers is responsible to all voters… It is
outrageous the salaried bureaucrat, fat-cat Neil Goodwin has the gall to tell
MPs to stop complaining and leave decisions up to pen-pushers like himself…
MPs must stand up and be counted and ensure the likes of Mr Goodwin never win
the day. An accountable health service is a better NHS.
Summary by
Keep our NHS Public
of
Mirror 3 March 2006
The only cure for the NHS is full independence. Leader
Sunday March 12, 2006 The Observer
Voters urged to send a message to the NHS.
Bristol Keep Our NHS Public is calling on voters to use the local
elections on Thursday to send a message to councils to defend the health
service against cuts. The call has been prompted by widespread service
reductions and job losses as the Government introduces health service reforms.
Keep Our NHS Public said councils should be using their scrutiny powers over
health services, but instead cuts and closures are often met with silence. The
overview and scrutiny committees of local authorities can examine changes -
such as services being moved, treatments withdrawn or wards closed - and can
refer cases to the Secretary of State if the community has not been properly
consulted or the committee considers the proposals will be bad for the local
health service. South Gloucestershire council recently sought a judicial
review over plans to close Frenchay Hospital but the city council's scrutiny
committee disagreed with the initiative. Gwyneth Powell Davies of Bristol Keep
Our NHS Public said: "Councillors have a responsibility to ensure people's
health services are protected. They need to ask deeper questions about local
reorganisation of the health service and the way it is being slimmed down to
make a space for the private sector. Now is the time for voters to hold
councillors to account."
Summary by
Keep our NHS Public
of Bristol Evening Post 3 May 2006
Service
redesign "needs scrutiny." Local government must have more involvement in
service redesign and commissioning to ensure public
representation within the NHS, according to Audit Commission chair Sir
Michael Lyons. He described the commission's hopes that the
currently-under-development comprehensive performance assessment system could
play an important role in establishing "how all public services in an area are
contributing to broad outcomes such as health, community safety, learning
environment and economic prosperity," and thereby increase cooperation between
local government and primary care trusts. He went on to lay out how the
introduction of
market based systems into the NHS would mean "waves of extinction through
public services in order to get the kind of innovation that markets produce."
He said that a system that remained "collectively funded and publicly
controlled" would not accept such a change.
Summary by
Keep our NHS Public
of Health
Service Journal 22 June 2006
All work and no say. My role as a non-executive in the NHS seemed
to be to toe the line, maintain a happy consensus and 'supervise
deterioration' of trust services. Peter Barker
Wednesday July 5, 2006 The Guardian [Non-executive directors seem to be
no more influential than
PPI forum members. Contrast elected
councillors, who collectively are in control of their local authorities]
Health
activists demand democracy. Members of Keep Our NHS Public in Hackney,
east
London, lobbied the board of their local primary care trust over major
cuts and redundancies that will affect mental health and suicide
prevention programmes, GP services and child protection. Over 100 staff and
members of the public protested. Health activist and Amicus union executive
member Gill George said, "They were discussing better communication with the
public while refusing to talk to us. They pushed through job cuts without
regard for democracy." Summary by
Keep our NHS Public
of Socialist
Worker 12 July 2006
Teething
troubles for care agendas. Difficulty in
relations with the NHS is
emerging as the number-one concern of social care leaders in a series of
"get-it-off-your-chest" meetings being held across England. Directors and lead
councillors of both adults' and children's services are complaining about a
paralysis of action brought on by structural change in the health service,
the adverse impact of
health spending cuts on partnership work and growing problems caused by
the NHS's so-called democratic deficit.
Summary by
Keep our NHS Public of Guardian
13 September 2006
Political parties on an independent NHS. At the Labour Party
Conference, Gordon Brown made a bid to define his leadership style by
proposing an independent NHS board. Meanwhile, health minister Andy Burnham
proposed his NHS constitution - apparently approved by Number 10 - and former
health secretary Alan Milburn mooted directly elected primary care trusts. A
week later at the Conservative conference, leader David Cameron's speech set
out to claim the NHS as his own. He proposed to remove bureaucracy and pass
power to the front line. Shadow health secretary Andrew Lansley wants to hand
power to GPs and hold managers to account through a proper commercial
framework. The Liberal Democrats, meanwhile, were in the throes of a policy
review but reiterated the general theme of giving power to locally elected
people. If the politicians are aligned on the need to take politics out of the
NHS, then so are policy analysts on the fundamental impossibility of doing so.
Gordon Brown's idea is not new. The NHS Alliance put forward the idea in a
paper in 2000, meeting with ministerial opposition. Chief executive Mike
Sobanja says: 'Our argument was about the role of politicians. They have to
decide on policy and national priorities and resource allocation. Then they
say to an independent board "these are the policies and this is the policy
framework; here is the money". The board then says either yes, we can deliver
with these resources or no we can't. In principle there's a contract.' Free
market think tank the Adam Smith Institute also proposed an independent board
in 2005. Its president, Masden Pirie, says with evident glee: 'I wonder if he
got the idea from us.' NHS Confederation policy director Nigel Edwards says
the independent board idea does not begin to solve the accountability issues.
'How do you get accountability for £100bn of tax payers' money ? Is it
conceivable for local people to say "the board is shutting my hospital" and a
local MP to say "it's nothing to do with us" ? People would ask "what the hell
are you there for then ?".' Jon Glasby, senior lecturer at Birmingham
University's Health Services Management Centre, argues that PCTs need more
legitimacy for decisions through local democracy. There are various ways of
tackling the lack of local democracy - elected PCTs, for example, or beefing
up overview and scrutiny - but Mr Glasby argues that handing commissioning
powers to local government would be the most powerful solution. Summary by
Keep our NHS Public
of Health Service Journal 12 October 2006
A Surrey state
of affairs. In a move that could have repercussions in cash-strapped
hospitals across the country,
Surrey county council has become the first local authority in England to
order a brake to be put on NHS staff and bed cuts. Epsom and St Helier
University Hospitals trust needs to save £24m over the next 18 months to hit
efficiency targets, and because primary care trusts are simply putting less
money its way as more work is done in the community. Its financial recovery
plan could see the loss of up to 200 beds, plus 480 jobs through early
redundancy, recruitment freezes and reorganisation.
Health scrutiny committees have the power to order local NHS trusts to
engage in public consultation when they are planning a "significant change in
service", such as closing maternity units, rather than ward closures or job
freezes. But Surrey's health scrutiny committee says the scale of cuts is
unacceptable, particularly as they will bite during the winter. On December 1,
the committee's chair, Chris Pitt, wrote to Lorraine Clifton, chief executive
of the trust, saying it considered the plans "a substantial variation or
development of service". He continued: "It was evident from the scale of the
cost savings to be made that the proposals would have an impact upon patients,
carers and the public. I wish to request that no further services are reduced
or moved from the Epsom hospital site until formal consultations have taken
place." Geoff Martin, head of campaigns at pressure group Health Emergency,
says Surrey's decision means the proposals could be put on hold for months
while the trust consults the public. He adds "that it shows that the wave of
panic cuts being bulldozed through our hospitals this winter as NHS trusts
fight to balance the books by next March." The trust wants further talks with
the council, but a spokesman says the trust didn't think it needed to halt any
proposals as it disagreed with the committee's interpretation of the cuts. "We
do not believe it represents a substantial variation in service," the
spokesman says. "We have received a letter from the chair of the committee. We
are considering its contents and will respond once we have taken appropriate
advice."
Summary by
Keep our NHS Public of Guardian
20 December 2006
Councils to be
given bigger role in planning health services. Local
government is to be given a significant role in planning health services
for the first time in more than 30 years, under an amendment the government is
tabling to its local government bill. Primary care trusts are to be given a
statutory duty to work with local councils to produce a local health needs
assessment covering public health and primary and community care. Priorities
will be decided locally. But once agreed they become potentially eligible for
funding through the burgeoning amounts of cash going to councils through
local
area agreement funding - a sum that Phil Woolas, the local government
minister, said will reach £5bn in two years. This would be a larger amount
than councils will be getting through the more general, non-earmarked, revenue
support grant that central government provides. The duty to plan jointly is "a
really significant change", Mr Woolas said, aimed at ensuring the health
service and local government work much more closely on priorities of their own
choosing. These could be anything from smoking cessation to teenage pregnancy
and putting rails into elderly people's homes. It gives councils a bigger role
in health than they have had since 1974, when the NHS reorganisation stripped
them of many of their health powers. The unelected primary care trusts will
remain responsible for commissioning NHS care, Mr Woolas said, but the bill
will force the local authority and the PCT to jointly produce and act on a
needs assessment for the area. Summary by
Keep our NHS Public of Financial
Times 22 January 2007
NHS staff
'should make treatment decisions'. The public would prefer health service
managers made decisions about which treatments should be offered by the NHS,
rather than MPs or local councillors, according to an NHS Confederation
survey. An Ipsos Mori survey of 1,000 members of the public found that while
9% believed MPs should have a say on whether the NHS should fund a medicine,
only 6% felt local councillors should have a role. In contrast, 23% said NHS
managers should play a part. Managers were the third most popular group,
behind clinicians (70%) and patient representatives (33%). Most respondents
said more than one group should be involved in making the decisions. Summary by
Keep our NHS Public of Public
Finance 26 January 2007. [While the response is not in support of
democracy, it is illuminating that it is not supportive of managers either,
and it is their umbrella body that commissioned the survey]
Cash help for
health trust. Councillors have agreed to help out a
struggling health trust with its finances.
Leicester City Council is going to give the city primary care trust more
than £1 million in return for services in the future. The primary care trust
is currently expecting a deficit of £10.9 million at the end of this financial
year. There have been assurances there will be no cost to the council or the
tax-payer as a result of the arrangement. Cabinet member for finance,
Councillor Peter Coley, said: "If we were not to do this, it could lead to
cuts in health services across the city. There is no good reason not to go
ahead with this." Summary by
Keep our NHS Public of Leicester
Mercury 29 January 2007
NHS trusts to
be added to LAA targets again. Ministers are saying that legislation will
be amended to ensure that NHS trusts are required to work with councils to
meet locally agreed targets. The local government white paper included
hospital trusts among those partners to be placed under a duty to co-operate
to agreed Local Area Agreement targets. But trusts had disappeared from the
list once the Bill was published two months later in December. The omission
fuelled concern that the government's commitment to partnership working across
local agencies was not as strong as it might be. Summary by
Keep our NHS Public of Public
Finance 23 February 2007
A way out of
this spectacle. Hilary Wainwright writes in a comment piece: "Gordon Brown
will be prime minister because Blair had become an electoral liability. MPs
knew voters had had enough of rampant privatisation and political sleaze. The
increase in public spending, especially on health and education, is constantly
undermined by a misconceived reliance on private business, resulting in a
roll-call of social inefficiencies, damaging fragmentation and escalating
costs. There's no lack of locally effective protests in the face of all this.
But how can they develop to have a sustained impact on the government
? Unions need to drop their caution and misplaced reliance on
behind-the-scenes deals with government. Instead, they should become the
backbone of national movements such as Keep Our NHS Public and the growing
movement for participatory, rather than privatised, forms of local government.
A party that discourages argument produces a political culture hostile to
experimental thinking. But in many towns and cities unions and community
groups are generating practical ideas for alternatives to the marketisation of
public services. These examples need to be publicised, learned from and
generalised. What could be the electoral repercussions of such movements
? It must be clear after this week's events that we can't expect a lead
from the parliamentary Labour party. Action elsewhere has to be reflected
there, but the dynamism has to be extra-parliamentary. Surely this kind of
campaigning needs to be put firmly on the British political agenda - now that
we have witnessed the nauseating spectacle of a Labour leader anointed without
an election."
Summary by
Keep our NHS Public of Guardian
19 May 2007
Milburn: Give
councils power to decide how NHS money is spent. Councils should decide
how NHS budgets are spent locally, the former health secretary Alan Milburn
has proposed. The prominent Blairite believes the idea is in line with Gordon
Brown's plans to devolve power and create an "enabling state" to answer the
Tory charge that he is a centraliser who will run a "Big Brother" government
when he succeeds Tony Blair next month. Mr Milburn's proposal would allow
closer integration between the NHS, social services and housing and could even
allow councils in England and Wales to bring in the free personal care
introduced in Scotland since devolution in 1999. In a speech at Durham
University, he argued that the NHS was "in a no-man's-land between a
nationally-run system and a locally-run one" and it was time to decide its
future. "I do not believe that a service as complex or large - employing 1.4
million people - can be run from Whitehall," he said. "If the NHS is to be
sensitive to the very different needs of different communities and if it is to
successfully tackle health inequalities, the balance of power should be local
rather than national." The former cabinet minister previously supported the
direct election of primary care trusts (PCTs). He now wants the commissioning
of local health services switched from PCTs to councils, which would avoid the
bureaucracy of holding separate elections. As a first step, Mr Milburn wants
the power over local health services handed to the best-performing local
authorities, which could be called "foundation councils" like the foundation
hospitals he set up as health secretary. NHS services would remain free at the
point of use but councils would be free to move money between services so they
could be tailored to local needs. Town halls would be freed from much central
government control and allowed to increase local taxes after a
referendum. He added: "It is the quality of the local school and hospital, the
local GP surgery and childcare centre that people care most about. Their
masters should be local communities not Whitehall departments. Ever since Nye
Bevan decided that the health service should be run separately there has been
a democratic deficit at its heart."
Summary by
Keep our NHS Public of Independent
25 May 2007
Trusts to be
held to local promises, says NHS chief. Primary care and acute trust are
to be held accountable for any promises they make to their local populations.
NHS chief executive David Nicholson said performance management would take
place at a local level. "We want to performance-manage organisations around
making sure trusts and PCTs deliver what they say they are going to deliver,"
he said. "Boards increasingly must know what their population and patients
need and stretch their ambition for patients and the organisation. It is
important to get traction in the system because boards have been looking
upwards to the centre. It is right that boards are accountable for the money
they spend, but they need to be accountable for the things they say they are
going to do. That is the next challenge." NHS Alliance chair Dr Michael Dixon
said: "Hopefully in the future PCTs could be performance-managed by the local
population through public and patient involvement, which has not been a great
success during the last few years." Mr Nicholson said the NHS was at a pivotal
stage with the emphasis on reform coming to an end. "We haven't got our heads
round how to use the reforms for the benefit of patients," he said. "We need
to look at how we empower the frontline people and give them the levers, which
I would argue are already there, to make those changes. I am trying to get the
department to a place where it lets people get on with it. I have to create an
environment, but no-one has ever been fired for improving services for
patients. There is an element of being surprised that if you push the system
you will be able to do more." He went on to criticise the lack of staff
development in the NHS. "We don't talent spot, we don't nurture, we don't
bring people on," he said. "It is difficult in terms of recruitment of chief
executives. In some cases there is only one person on a list who could be
appointed and in some cases none. "The average length of post is about 700
days for managers, who will be working alongside clinicians with 30 years'
experience. We don't have a large number of clinicians in management
positions. The more we get capable clinicians in senior positions, the more
likely we are [to succeed] in making the changes we need to."
Summary by
Keep our NHS Public of Health
Service Journal 7 June 2007
Tide turns on
health secretary's 'undermining' local influence. Headline-grabbing
marches through town centres, loud heckles at public meetings, passionate
newspaper campaigns flanked by colourful logos foretelling doom - the common
public response to consultations on hospital service changes has become a
familiar signal to many of a failing NHS. It is a virtual certainty that any
reconfiguration plans will meet with a degree of local opposition, but it is
all the more difficult for managers when public confidence is further eroded
by accusations that the changes are a 'done deal'. In theory the involvement
of the independent reconfiguration panel should put doubting minds to rest by
giving objective advice which, though not set in stone, is expected to be
heeded and implemented in the local NHS. But a growing tide of resentment
towards the process argues that it lacks independence, put starkly by a
Commons health select committee report in March and again last week by the
Institute for Public Policy Research. A view commonly held by campaigners was
echoed at the select committee's hearings by London-based solicitor Richard
Stein, who has made a career of challenging consultations in court. The
process has 'no credibility whatsoever', he said: 'Most of the things
[opponents to service changes] do not like are driven by the secretary of
state, so to appeal against their implementation locally to the secretary of
state will not deliver anything, and that is a real shame.' The panel has
published three reports on local service changes and is looking at three more
cases - but 14 proposals have not been formally referred. The health select
committee said that when questioned by members the health secretary 'was not
able to give a clear answer' on why she referred so few cases. It concluded
that while the system was good 'in theory', the health secretary's role served
to 'undermine public confidence in the consultation procedure system'.
Reconfiguration panel chief executive Tony Shaw emphasises the panel's
independence and rejects the view of some local campaigners that the body is
there to rubber-stamp the wishes of the local NHS and the health secretary,
who are likely to be singing from the same hymn sheet. He points to its first
review, of acute services in East Kent Hospitals trust, which he says was 'a
bold first set of recommendations'. The 2003 review urged the trust to scrap a
proposed private finance initiative scheme and provide a network of services
across three sites. Kent and Canterbury Hospital's accident and emergency
department should be closed, the panel agreed.
Summary by
Keep our NHS Public of Health
Service Journal 7 June 2007
Johnson
review seeks to win over demoralised NHS staff. Cure for
gloom is 'reform led by workforce'. Surgeon leads reappraisal in new role as
minister. Alan Johnson, the health secretary, yesterday announced a
thorough review of the NHS, with an admission that the government was
responsible for the battered morale evident among its 1.3 million staff. Sir
Ara Darzi, a world-renowned surgeon, who became a health minister in last
week's reshuffle, will be conducting the 11-month reappraisal, looking at how
doctors, nurses and other healthcare staff can regain ownership of NHS reform.
Mr Johnson said the government had to accept blame for the low morale in the
workforce. "The reality on the ground is that there is a gloomy mood. There
has been an
awful lot of change in a short period. Staff feel overwhelmed by it. They
feel it all flowed down from Whitehall." The review will not challenge the
commitment to allow
patients to choose between NHS hospitals, neither lose the pledge to cut
maximum patient waiting times to 18 weeks. Sir Ara would not look for
alternative policies but would try to engage staff in finding practical local
solutions, the key to winning public support for change. "We need to learn
from staff what are the challenges and obstacles to delivering excellence," he
said. Mr Johnson's only departure from the course set by Patricia Hewitt, his
predecessor, was to downplay the
role of the private sector. He said he would only sign contracts for more
independent sector treatment centres if they were needed to fill gaps in
NHS capacity. He appeared to abandon the Blairite view that private
involvement helped spur competition, whether or not extra capacity was
required. Mr Johnson told MPs the review was a "once-in-a-generation
opportunity to ensure that a properly resourced NHS is clinically led,
patient-centred and locally accountable". The
results would be used to write an NHS constitution next year. He said: "There
will be no further centrally dictated, top-down, restructuring to primary care
trusts and strategic health authorities for the foreseeable future." The
review will not bar change for 11 months, but any proposals to
close hospitals or wards that were opposed by authority scrutiny
committees would be sent for review by an independent panel. Extra funding of
£50m would be available for tackling hospital "super bugs". Andrew Lansley,
the shadow health secretary, said that after the waste of "vast sums of
taxpayers' money" this was yet another NHS review "with no answers". He said:
"Conservatives have set out a blueprint for the NHS. So come on Alan Johnson,
steal our clothes. Show the health service and the public that politicians can
work together on this." Norman Lamb, Liberal Democrat health spokesman, said
the review failed to address failings. "It says nothing about the democratic
deficit in the NHS, which has seen people ... have little say in whether their
local hospitals get shut down." John Carvel, social affairs editor
Thursday July 5, 2007 The Guardian
Councils may
win bigger say over NHS. Local government may be given greater control
over the NHS, despite promises from health secretary Alan Johnson that there
would be no structural upheavals in the NHS "for the foreseeable future". A
greater role for councils in the NHS, or the introduction of some form of
local democracy, has been mooted by three senior ministers in the last week.
Jack Straw, the justice minister, has said: "Too much power has been handed
over to unelected health service quangos and many others." Hazel Blears, the
new communities secretary said in her first official speech that: "In the
longer term it is clear to me that we need to be thinking about giving local
people more control over their NHS and their police force. It is early days,
but I will be discussing with my ministerial colleagues how we make that
happen." Mr Johnson himself has also hinted at such a move in stating that the
government's review of the NHS was aimed at producing an NHS based "less on
central direction" with an emphasis on "patient control, choice and local
accountability". Councils already have overview and scrutiny powers which
enable them to refer any big changes to the secretary of state for review by
an independent panel, and are set to have the power to force primary care
trusts to co-operate in drawing up local area agreements concerning the
council's desires for public services. However both Ms Blears' and Mr Straw's
comments suggest a far greater leap in introducing local democracy to the
health service which may cut through the current emphasis on choice and
competition. Although passing more direct control over services to councils
would reignite a debate about who should control healthcare, it may mesh with
the prime minister's plans for greater devolution of power.
Summary by Keep our NHS Public of Financial
Times 10 July 2007
Public sector targets to be scrapped. New approach gives more power
to local councils and NHS trusts. A bonfire of government targets to ease red
tape affecting schools, hospitals and town halls will be ordered tomorrow as
part of a sweeping reform of public services, the Guardian can reveal. Most of
the 110 Whitehall-imposed priorities that have dominated the public sector for
the past nine years will be abandoned . Andy Burnham, the chief secretary to
the Treasury, is coordinating a move to end one of the defining
characteristics of the Blair years by scrapping all but 30 top-down targets
used to vet performance. The targets - from raising the GCSE pass rate to
reducing the fear of crime - helped to drive through the big pledges in
Labour's election manifestos. But they rankled with doctors, teachers and
other public servants who felt their professional discretion had been
curtailed. In an interview with the Guardian today, Mr Burnham set out a new
approach, making local service chiefs responsible for setting performance
objectives and answering to local communities if they are not ambitious
enough. He said: "This is the opening of a new chapter ... If we get this
right, the style of government will feel different. We want to give out a
message of more trust in public bodies." Under the system, there will be no
more than 30 public service agreements, committing Whitehall departments to
use their budgets over the three years to 2010/11 to achieve the government's
goals. The agreements will be monitored using indicators of national and local
performance. A few - such as progress towards meeting the pledge to cut
maximum hospital waiting times to 18 weeks by the end of 2008 - will remain as
nationally set priorities with clear measurable objectives. But most will
depend on local decisions by councils, NHS primary care trusts and other
service chiefs to set targets reflecting local needs and priorities. John
Carvel, social affairs editor
Wednesday July 18, 2007 The Guardian
We're not going local when it comes to health. What a difference a
couple of months makes, give or take a new prime minister. In June, the idea
of an independent NHS was all the rage. "Get those politicians out of it!" was
the cry. Schemes were drafted to turn David Nicholson's NHS executive into a
fully-fledged corporation, at arm's length from ministers. Now, "Get those
politicians back in!" is the call. During the summer, a couple of cabinet
ministers - including Jack Straw, the justice secretary - said councillors
should have a new role in health decision-making. Even before it has passed
parliament, the local government and public involvement in the health bill is
being condemned as lukewarm. It establishes weird and wonderful new schemes -
local involvement networks - to give people a bit of a say in primary care.
But when not only the communities secretary, Hazel Blears, but Hilary Benn at
environment and Ed Balls, the children's secretary (and arch-Brownite) are
extolling local democracy and the transfer of power and responsibility to
localities, why should councils be excluded from health? Can a local authority
be a place-shaper and not take a more central part in the health service?
Councils do already have a health role, as scrutineers, able to compile
reports. From next year, primary care trusts will be required to cooperate
with local government in joint reviews of health and care needs. But when the
Centre for Public Scrutiny recently took a look at this boundary, it found the
NHS confused between "involving people" and "being held to account". Aren't we
all? The public complains when it isn't consulted but refuses to press buttons
- let alone turn out to meetings - when opportunities to take decisions are
presented. "The centre can't hack it" became the consensus of the later Blair
era, but that doesn't automatically make the local option work, especially
when it comes to health. Yet health's local dimension will loom larger this
autumn. While Gordon Brown has successfully parked bigger health questions by
setting up Lord Darzi's review, Labour ministers may find it hard not to
follow the logic of their new enthusiasm for localism by putting councillors
on health trusts, for instance. David Cameron's bid to use hospital closures
as a rallying cry has upped the stakes. Who does legitimately speak on behalf
of "the community" when a cottage hospital is being shut? How helpful (to the
government) it would be if councils took the rationalisers' line and added
weight to the case for concentrating specialised care. County councils and big
unitaries just might. If debate about local involvement in health does take
off, it's got to be sharper. Until now, evidence has been lacking on all
sides. We've not heard much from professional managers. Their historic
challenge in health has been to subject doctors to external discipline that
goes beyond mere control of money and into assessment of their professional
qualities and competence. Would council managers do any better? Does local
authority experience with such public service professionals as teachers or
architects tell us how they might handle clinicians? And, of course, until a
generation ago, councils did employ some doctors. Remember, the NHS was
established as a national service largely because the Attlee government faced
implacable antagonism from the medical profession towards local control. If
the principal problem in primary care is GPs and their status as
semi-independent, self-employed contractors, would the town and county halls
offer any solution? For all that the health accountability debate has moved on
this summer, public attitudes remain spongily ambiguous. With councillors
comes what the British Medical Association castigates as political
interference, with the backing of the polls. What would be the point of giving
councillors more say in health unless they started to import judgments made on
a partisan or ideological basis - or started to insist that ostensibly
clinical judgments made by doctors that involve "the community" (and most do)
are invigilated by the community's elected representatives? Imagine the
clinical furore. In the run-up to a general election, Labour is unlikely to
want to open that can of worms. Instead, ministers will go on saying how much
they favour all manner of schemes to promote public involvement - including
Blears' scheme for community kitties. But they will go on stopping short of
establishing formal accountability, the kind that comes from appealing a
decision to an elected politician or seeing decisions on public services -
including health - made directly and openly by elected representatives. David
Walker
Wednesday September 5, 2007 Guardian
This could be the year local power prevails. A motto for
2008? Rein in the quango state. Bring the local back into government. Make
most public services - particularly health and policing - accountable to
strengthened town and county halls. Let the best councils oversee primary and
acute health. Break down, or scrap, police authorities and hand their powers
to councils at command unit level. Formally scrutinise those unaccountable
government agencies and higher education institutions. In short, take central
government at its word. Join up services in a way that will always elude
Whitehall. Seize the higher social and economic ground. It is no longer a tall
order. Interviewed recently by Society Guardian, the communities and local
government secretary, Hazel Blears, was clear that the future lay in councils
sharing budgets, as well as performance indicators, with, say, local health
trusts. Peter Hetherington
The Guardian, Wednesday January 9 2008
PETITIONS
- Petition to: Why do we
have to pay and still have no real say - NHS Trusts and PCTs? Make NHS
Trust/PCTs accountable to their local residents in terms of service delivery
and best practice. If members of staff (or the general public) make
suggestions of best practice that are beneficial to the residents of their
local NHS Trust and PCT, staff should not lose their pin number or be subject
to a disciplinary for putting these suggestions forward. The suggestions
should be robustly and proactively applied (particularly if they make common
sense). Any consultations led by the NHS and PCT should have the transparency
and integrity to fulfil the remit of any of these consultations and not be
done purely as a tick box exercise! Especially in the areas or
hygiene/cleanliness, budgeting, staffing, allocation of life saving drugs, all
race equality issues (applying local race equality schemes), malpractice and
abuses towards vulnerable patients. After all we do pay for a service that we
are not getting value for money for and the wrong people are being victimised
for trying to improve things in the NHS.
(updated 14 June 2007)
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