COUNCILLORS, without wanting to sound unduly dramatic in these portentous times – there is a crisis of democracy occurring in the process of implementation of the Sustainability and Transformation Plans. Whilst most health professionals and campaigners agree these mass infrastructure ‘reconfigurations’ are a convenient way to devolve £22 billion of cuts to already financially besieged localities, there is another damaging crisis enveloping the NHS administration.
Prior to the Five Year Forward View and STPs, the capacity of the public to influence management of health services was questionable: patient groups were always largely window dressing and toothless.
Now, despite expensive bureaucratic machinery surrounding ‘patient engagement’ exercises, the extent to which people can hold decision makers to account remains severely limited.
The NHS is framed by prescriptive, centrally driven sets of metrics – waiting times, audit regimes, control totals – command structures also imposed from the centre. These clearly restrict meaningful stakeholder participation.
Perhaps worst of all is the language barrier – slippery management-speak platitudes and ‘revolutionary new buzzwords’ – that dupe us into engaging like consumers rather than citizen-patients.
Plans are presented as a technical exercise with services having only instrumental value – a means to an end.
With the latest changes there has been a transformation from ‘questionable public accountability to no discernible public accountability at all’.
Under instructions from NHS England, the Buckinghamshire, Oxfordshire and West Berkshire STP largely remains secret. It has been termed – by respected organ of management, the Health Service Journal – ‘extra-legislative reform’. But among the plethora of management organisations involved, we cannot know who’s in charge, of what, or where responsibility resides.
Because the changes have already been decided, the STP itself is merely an explanation, so that consultation or engagement is essentially along the lines of ‘Let’s tell the people what the changes are.’
THIS IS NOT PUBLIC ENGAGEMENT
And the accelerating speed of implementation has meant the plans effectively have been ‘protected from too much scrutiny’ by the ignorant masses – us.
NO WONDER PEOPLE ARE ANGRY WHEN HOSPITALS AND GP SURGERIES ARE THREATENED
Hospitals and surgeries are more than just buildings. They are symbolic – wrapped up in identity and community – places of suffering, hopes, fears, anxieties, emotions, values, security – ‘existing at the junction of life and death.’ Places that have meanings way beyond the narrow instrumentalism and rationality of cost controls.
In other words, they are the embodiment of the NHS.
Real democracy must provide appropriate spaces for the expression of these voices and these meanings.
Reconfigurations must be properly and openly stress-tested to ensure they are credible and can be delivered by and for the very people who are most affected.
A STORM IS SIMMERING IN OXFORDSHIRE – where even a Tory MP is challenging the cuts and downgrades at the Banbury Horton.
THIS HOSC MUST TAKE A STAND
- When public consultation is phased to ensure there will be no bad news – theoretically – until after the Council Elections
- When consultation is partial and post hoc
- When plans do not connect with the entire BOB STP – a bedpan dropped in Newbury can be heard rattling in Chipping Norton!
- When plans fail to include detailed financial plans/appendices and the cost savings for every change of service
- And when plans omit risk assessments for each change proposed.
THEN WE CALL ON YOU
- To publish your findings and concerns
- To refuse to rubber-stamp
- To invoke your powers to hold managers to account
- To block controversial changes pending a decision by the Secretary of State and
- To demand a substantial increase in funding from government to save our local health services
AND THEN, COUNCILLORS,
The local democratic accountability vested in this Scrutiny Committee may be preserved.
[In the compilation of this address, Veronica Treacher and Oxfordshire KONP wish to acknowledge and reference a timely article by Dr Carl Walker of the University of Brighton, critiquing STPs and analysing the nature of the democratic crisis confronting local authorities across the country: