Steve Baker is the Member of Parliament for Wycombe and Chairs the Conservative Public Services Committee.
Nothing irritates and angers my constituents more than the long-term leeching away of services from Wycombe Hospital. While the NHS goes through the motions of “consultation” over these changes, NHS accountability to the public is a fraud. Consultation meetings are poorly-attended and no wonder, for all the difference they make. They are little more than sales seminars, exercises in manipulation and box-ticking. It cannot be allowed to go on.
It’s true that, over the years, medical practice and management have changed so that the district general hospitals designed for the 60s have lost much-loved services like A&E and maternity to centralisation. But why has medicine been allowed to evolve so far from the clearly-expressed wishes of the people who pay for it? Why are clinical staff doing so much that the public don’t especially value? Why are the public squandering crucial services like A&E for treatment of minor conditions, when a timely trip to the GP would be convenient and cost-effective? Why is it all so expensive?
These are the kind of questions which the Conservative Public Services Committee, which I chair, will be exploring. While the Number 10 Policy Unit looks first to Government and Parliamentary colleagues, my Committee will look outwards. We are bringing the best ideas from think tanks into Parliament and under the practical scrutiny of Conservative MPs before passing them to Number 10. Over the months ahead, I intend to step up that process and widen the audience to include the voluntary party and, crucially, our agents. If a policy can’t be explained in a box on a leaflet to win support, ought we to be doing it? We need common-sense Conservative policies which have been thought through, which we know work and which we can explain simply.
That’s why it’s time to put patients in charge of the NHS.
With growing pressure on out-of-hours and urgent care and with action still needed following the Berwick and Keogh reports, the NHS requires further substantial change. NHS England Medical Director Sir Bruce Keogh has explained that engaging patients in the NHS can have a major impact on the quality of care. As we come closer to the next general election, the Conservative Party has a generational opportunity to improve transparency by championing reforms that would make the NHS fully accountable to patients and the public in a way proven before the nationalisation of our hospitals.
It is imperative we solve the present major crisis of accountability. Scarce resources and burgeoning demand inevitably mean rationing takes place throughout the NHS. Managers, GPs and other staff take difficult decisions about the availability and quality of services. Contracts are negotiated centrally and patients lose out. At no point do patients have power over how those decisions are made and how care is delivered. We ought not to be surprised that the tax-paying public is in constant revolt over NHS “reconfigurations” removing services on which they rely for the most vulnerable members of their families.
In that context, the think tank Civitas has published “A National Health Service for Patients” by Anton Howes, which sets out a solution to this crisis of accountability. It proposes allowing members of the public to form “patient-led commissioning groups”, to operate in competition with the new GP-led clinical commissioning groups. Patient-led commissioning groups would be consumer mutuals, directly accountable to the patients who sign up to them and able to drive GPs and healthcare providers to increase access to and quality of treatments.
By decentralising the negotiation of GPs’ contracts to individual patient-led commissioning groups, there would be the opportunity for patients to secure work-friendly and night-time opening hours and potentially even old-fashioned home visits from GPs, without a major fight between the British Medical Association and the Health Secretary. When faced with ward or hospital closures, local campaigners or politicians would have the opportunity to set up patient-led groups to act on behalf of affected locals who sign up, using their commissioning powers to determine services, taking responsibility for the consequences.
Patient-led commissioning groups offer an opportunity to improve radically the empowerment of the public and the responsiveness of the NHS. Membership-based bodies like unions, co-operatives and friendly societies are exactly the sorts of organisations which already possess the infrastructure to establish their own patient-led commissioning groups. This policy provides them an opportunity to offer their members more accountable health services and provides an opportunity for the Conservative Party to deliver on the promise of the 2010 manifesto, an invitation to join the government of Britain.
Best of all, it’s a proven idea. Pick up a copy of David G Green’s Working Class Patients and the Medical Establishment and you’ll find an answer to every objection in the history of British healthcare prior to the NHS.
It’s time to enable healthcare decisions to be taken away from the monopolistic power of an unaccountable elite and placed with an ever-more informed public. People know what they want and they know what they are getting today is not it. The introduction of patient-led commissioning groups is exactly the sort of proposal that the Conservative Party must adopt if it is to honour the spirit of the 2010 manifesto and David Cameron’s leadership. It is an idea which provides opportunity to drastically improve the NHS’ responsiveness to the public and to do it through means which embrace the best, common-sense traditions of our country.
I look forward to inviting Anton Howes and Civitas to make their pitch in Parliament.