New Life for Health
The study
published in April 2000 is an important move towards democratic accountability in the health service.
The Commission was set up in March 1999 by the Association of Community Health councils for England and Wales
(ACHCEW) in order independently to examine the issue of public interest, and how it is served by the system of accountability in the
NHS.
The recommendations are broadly consistent with the objects of this campaign.
- The NHS should be given a constitution to protect its founding principles and give positive shape to government policies and its own practice.
- The NHS should become a public corporation at arm's length from the government with its own board and operational freedom.
- The NHS should be made democratic and accountable at local and regional level; locally through transforming health authorities into elected bodies with a measure of appointment for the sake of expertise and balance, and eventually at regional level through regional assemblies in England as well as the Scottish Parliament and assemblies in Wales and Northern Ireland. As an interim measure in England, regional accountability should rest with the new indirectly elected regional chambers as they come into being.
- NHS trusts should be made accountable to representative health authorities locally, or to more representative versions of the new Primary Care Groups (PCGs) and Primary Care Trusts (PCTs).
- The public should be given a right of access to all meetings, minutes and policy papers of all executive and advisory public bodies within the NHS, subject to the protection of individual privacy.
- Within a diverse multi-ethnic community the NHS should make an explicit commitment to the promotion of equality to its system of governance, provision of health care and treatment of staff.
- The value judgements determining the NHS's efficiency and use of resources should be explicitly opened up to public scrutiny through the availability of all information determining financial and budgetary decision making.
- Lay representation on the new PCGs and PCTs should be strengthened, perhaps by way of election by the relevant patient body, and they should serve populations that are geographically contiguous with health authority boundaries.
- All appointments to NHS trusts, PCGs and PCTs should be advertised and made by nomination committees established by representative health authorities, and their representation should reflect the whole community.
- The network of community health councils should be strengthened by extra central public funding and an enhanced statutory role as patient watchdogs and advocates.
All complaints from patients and their families should be handled by genuinely independent review panels.
- The Select Committee on Health should be strengthened by adequate financial and staff resources.
- The Health Ombudsman should have the powers to inquire into policy issues and to initiate inquiries under clear criteria, with sufficient resources to follow up his recommendations.
- Substantial lay representation should be introduced by law into all the regulatory agencies including the new Care Standards Commission, General Medical Council and al the professional associations, royal colleges and other bodies that set standards of care and provide training for health professionals and workers and regulate private providers.
- To ensure a genuinely transparent health service, the Freedom of Information Bill should be amended to open up government policy-making to public scrutiny and the Commissioner for Open Government should be given the power to investigate and overrule official refusals to provide information.
- All independent contractors and private health providers must subscribe to the same rules of oversight, transparency, inspection and accountability as public bodies within the NHS.
- The Patients Charter should become part of the NHS's core constitution.
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