Powerful professional bodies successfully resisting efforts to make their members accountable for their policy decisions.
I will give a few examples.
The Government launched NHS Direct as an additional service offering health advice to people who found it inconvenient to visit a doctor. Less than two years later it was announced that NHS Direct would be a gatekeeper who would have to be passed before getting an appointment to see a doctor. The Government did not reveal this policy when the new service was first announced.
You will be hearing tonight from people who will lose their jobs as a result of a grandiose scheme to create a super-hospital in Dudley. Large-scale schemes always cost more and achieve less than planned, as many national computer developments show, along with the Channel Tunnel and the Millennium Dome.
Some of the money for new developments in the NHS is clawed back through so-called “efficiency savings”. Real efficiency savings, such as through better or cheaper scanning equipment, are used not to save money but to treat more patients. The so called “efficiency savings” are being made by cutting ward cleaning and other essential services at a time when more and more patients are catching infections in hospital. The Government’s announcement this week of measures to improve ward cleanliness is a belated recognition that its policy of “efficiency savings” damages health.
The link between BSE (Mad Cow Disease) and the fatal human disease CJD was suspected by Government scientists long before it was made public. But their researches were blocked, they were gagged for years, and then they were made redundant, as a result of decisions by the Secretary of State for Health.
The case of David Glass illustrates three aspects of mismanagement in the Health Service. He was born brain-damaged and not expected to survive. Several years later he needed treatment in hospital in Portsmouth, but doctors decided it was in his interests to die and resolved to give him a fatal dose of diamorphine. His family removed him from the ward by force, and two years later he is still alive. The local NHS management took the family to court twice, once to establish the doctors’ legal right to kill the child, and once to prosecute them for assault, as a result of which three people were sent to prison. While this was happening, the General Medical Council issued guidance to doctors that said that they should consult patients and their families before taking action designed to cause the patient to die, but that the ultimate decision was the doctor’s. And when an Opposition MP, Anne
Winterton, introduced a Private Member’s Bill to make it illegal for a doctor intentionally to cause a patient to die, the Government opposed the Bill.
The future
When we have local democratically elected bodies responsible for the Health Service locally, most of the mismanagement locally either will not happen or will be stopped as soon as it receives local publicity. The elected representatives should make the doctors accountable. While decisions on the most appropriate treatment for a patient are normally professional decisions, when doctors decide that a patient would be better dead, or that mentally infirm patients should be refused orthopaedic surgery, they are making decisions on matters where public opinion should outweigh their own prejudices.
Ministers pursuing their careers from Department to Department and seeking to establish their names with headline-grabbing initiatives dominate Central Government. Parliament ought to be a check on Ministers, but too many MPs keep quiet because they want to be Ministers too. The role of Central Government should be confined to matters that cannot be decided locally. Even on those matters, as the cover-up on BSE shows, we cannot trust Central Government, and we need to change the relationships so that local democratic bodies ensure that national and international issues are publicised and debated and hold national bodies accountable.
In the first instance the way forward is through the Hutton Commission’s recommendations, which include a Charter for the NHS and elements of democratic governance. The Association of Community Health Councils for England and Wales set up the Commission, after we started our Campaign. The Government’s response has been to ignore the recommendations and to propose the abolition of Community Health Councils.
The Campaign
I started the Campaign for Health Service Democracy as a result of my own and my mother’s experiences. Our experience is that indifferent Governments reluctant to make necessary changes can be made to listen. We have much more information, which is on the Campaign website. The website address is on the handout.
Handover
I now hand over to Anne Burge, who served on a Community Health Council and is now Membership Secretary of Freedom to Care.