Local decision making in the NHS today.
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Campaign for Health Service Democracy Local decision making in the NHS today. b y Sheila Porter-WilliamsI have been campaigning for decisions about the health service to be made at local level by people who are democratically accountable to local residents. The Government also says it is in favour of local decision making, but the essential requirement of democratic accountability is missing from Government policy. I have a copy of a letter from the National Health Service Executive written to someone I shall call Mrs Frost living in Eastland. Mrs Frost believes that her medical condition will be eased by homoeopathic treatment. Homoeopathic treatment is provided by the NHS, and there is an NHS Homoeopathic Hospital in London that treats patients from all over the country. Many Health Authorities will pay for homoeopathic treatments, but Eastland will not. Mrs Frost wrote to the Secretary of State to complain of Eastland’s policy as an example of postcode rationing. The reply from the National Health Service Executive was that it was a local decision and not the Secretary of State’s responsibility. Who appoints the Health Authority members? The Secretary of State. To whom are they accountable? The Secretary of State. And yet a spokesperson for the Secretary of State readily says that Health Authority decisions are local matters for which the Secretary of State is not answerable. NHS Trusts manage the hospitals and other direct services in the NHS. They were set up to be run as though they were businesses, working to contract to make a profit providing the services commissioned by the Health Authorities. They soon developed the faults of private businesses. Staff were encouraged to act as though their function were not simply to optimise health and relieve suffering, but primarily to promote the business of the Trust. So patients have been passed from consultant to consultant to maximise income. Risky operations have been performed and advertised to Health Authorities to attract new business. And bad news has been kept secret. Anyone revealing embarrassing truths has been punished. The University Hospitals Coventry and Warwickshire NHS Trust (which is based at Walsgrave Hospital and also manages my local hospital in Rugby) has been heavily criticised locally for various reasons. It is believed to have unnecessarily run down services at the Rugby hospital and to have reneged on promises to restore a wide range of services there. It prevents staff from speaking to the media. It was rated with no stars after being exposed for putting five patients in wards equipped for four. It requires pre-registration house officers to exceed their contractual weekly limit of 56 hours (which itself is a derogation from the European Working Time Directive which has a general weekly limit of 48 hours), and as a result the university may remove the posts, adding to the staffing pressures. In October 2001 Rugby Borough Council, which, when a bill now before Parliament is passed, will have a duty to scrutinise NHS bodies in its area, invited the Trust’s Chief Executive to discuss his recovery plan with the Council. The meeting was in private. In discussion in the local press, a councillor claimed that the Trust Chief Executive would have walked out if the meeting had been opened to the public. Under local government law, all meetings must be open to the public unless the business to be discussed is covered by a statutory exemption. The exemption claimed relates to commercial confidentiality. How can a public body managing local hospitals legitimately hide commercial secrets from the residents it was created to serve? At another hospital a doctor who took his duties as medical auditor seriously has recently been dismissed. He found that his trade union does not assist whistleblowers on principle, presumably because they see their first duty as being to their members whose incapacity has been exposed. Another doctor is taking legal action trying to prevent a Health Authority warning his former patients that he is HIV-positive. These points show that the corruption of cover-up and secrecy is not confined to management but affects professionals individually and collectively. Alan Milburn announced in October 2001 that he rejected Aneurin Bevan’s view that the Minister of Health was responsible for everything in the NHS. But if in practice it is unavoidable that policy decisions are devolved to local level and the Secretary of State has insufficient attention span to hold local managers accountable, it is even more vital that the local managers should be democratically accountable to their local communities. Campaign for Health Service Democracy. |
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Sheila
Porter-Williams |