Red Pepper January 2002

Campaign for Health Service Democracy

The health service needs both to be publicly accountable and to be managed according to policies determined through a democratic process. It is a long way short of these aims. The Government is making faltering steps to improving public accountability, but it is doing nothing to introduce democratic governance.

The medical profession claims the right after consultation to decide when a terminally ill patient should die. Some doctors without consultation have tried to kill patients who subsequently recovered, arguing that their disabilities resulted in a low quality of life. The courts have ruled that a doctor is entitled to end a patient’s life, and relatives who forcibly removed a child called David Glass from hospital to escape a lethal injection were sent to prison. Parliament needs to change the law to give patients the right, if they wish, to treatment prolonging life and to refuse treatment likely to cause death.

Some doctors refuse essential treatments because of their individual prejudices. My mother was twice contemptuously refused necessary surgery because she was mentally infirm. Doctors must be made accountable for their policies in deciding who should be treated.

NHS Trusts act so much like commercial organisations that they punish their staff for disclosing wrong-doing and they refuse to let their patients and the residents they serve know how they propose to change policies. The chief executive of my local hospital only agreed to meet councillors on condition that the meeting was in private, using "commercial confidentiality" as the excuse. There is no place for commercial confidentiality in the standards of public services and their impact on citizens. It should be outlawed in NHS bodies and in private sector bodies providing public services under contract.

The main public accountability at present is through community health councils (CHCs). They are not directly elected, though they do include councillors and representatives of the voluntary sector. Their scope is limited. Some are active, while others have such a narrow view of their role that they try to keep their membership lists secret. However the Government started badly by proposing the abolition of CHCs without clearly explaining how they would be replaced. It has since consulted on new arrangements involving patients’ forums, patients’ advocacy services and a statutory duty of scrutiny by local authorities. Final arrangements have yet to be made, but they seem likely to improve the NHS’s public accountability. The detailed arrangements will need to be watched.

We also need direct elections to local bodies providing and making policy decisions about health services. The Government is introducing Primary Care Trusts this year, but their membership will be entirely appointed. Decisions on matters like closure of hospitals will never get public acceptance unless they are made democratically after informed debate. The Government still needs to be persuaded of this.