Why NHS must engage the public over health and social care reform plans
Guest blogger Darren Wright, with 20 years’ management experience across local government and the NHS, argues that Birmingham city councillors are right to be concerned about the way the latest plans to integrate health and social care are progressing.
The NHS-led Sustainability and Transformation Plans (STPs) present Birmingham and its neighbours with a great opportunity.
An opportunity to simplify a bewilderingly complex health system. An opportunity to place health and social care on an equal footing and recognise the contribution they both make to our wellbeing. An opportunity to reduce the transactional costs involved in moving notional money from one publicly run organisation to another.
All these opportunities are potentially there, but whilst the process is clouded in secrecy we are right to be concerned whether or not transformation will be truly sustainable. Birmingham city councillors rightly expressed concern that these plans also have potential to pose great risk to services that we rely on.
The process to develop these plans has not been explicit in what the final objective is.
Are we transforming services in order to fit within an ever decreasing financial envelope or are we transforming into a better integrated system?
Whilst both are theoretically possible, the history of NHS reorganisations indicates that achieving both are unlikely.
It might well be presented that external factors are the impetus behind the speed of the planning process and the lack of transparency. The current health and social care environment is a challenging one to develop services in but not one that is unexpected.
The challenges created by an ageing population have been known for decades. Flat funding in the NHS and decreased funding in local authorities has been set out to all of us since the financial crisis. The absence of proper workforce planning, and the consequences of that, similarly have been known for years.
All of these external factors have not come about since the last time we radically transformed services in 2010.
The formative plans might be discounted as “possible options” but we are already seeing the tangible impact of planning. The takeover of Heart of England NHS Trust by University Hospital Birmingham is surely a key element of transformation. Equally the merger of Clinical Commissioning Groups to create one that covers Solihull and three quarters of Birmingham must be part of these plans.
At least if they’re not key elements of the STP process then it would appear that there are two parallel transformation projects in place.
Both these changes are significant. Both, in their own way, are potentially good. For too long NHS Trusts, in Birmingham, have competed with each other in the artificial market place. The original plans for Clinical Commissioning Groups bore no relationship with geography that residents understood and resulted in remote and unaccountable bodies.
We should be aware that both changes also pose risk. The financial crisis at Heart of England NHS Trust developed through a culture of secrecy, a lack of management of emergency medicine, disinterested national regulation and weak local commissioning. Whilst University Hospital Birmingham is recognised as a well-run hospital, what is in place to prevent contagion across a much larger trust? We should remember that Heart of England NHS Trust was also recognised as a well-run Trust only a few years ago when it took over Good Hope Trust.
Situations change and it is imperative that Birmingham has a system resilient enough to absorb similar future changes. One very large Trust, providing the majority of acute care and emergency medicine might mean that there is nobody to pick up the pieces in the future.
With the proposals to create a single CCG covering most of Birmingham there is the obvious question as to why only most of Birmingham? Why do the communities of West Birmingham not benefit from these economies of scale?
These are challenges that need to be posed as part of the STP process. These are challenges that will only be posed by people outside of the Health and Social Care system.
It might be suggested that NHS England have made this process secretive. This is disingenuous. The NHS cannot unilaterally get around the statutory requirement to consult with Councillors on significant variations of service. Councillors are best placed to give strategic consideration of the full range for proposed changes.
Within all of the process to transform there has been a worrying absence of the nationally funded patient voice. As with the historic Community Health Councils, Healthwatch has a statutory role to promote significant changes of services to the public and gather their views. Whether the organisation does not understand its role is not clear, but as yet it has been silent on significant plans that impact patients.
Someone needs to pick up the strategic scrutiny role to not only protect the public interest but also to make better services. There is a salutary lesson in the creation of Birmingham’s Clinical Commissioning Groups. Many patient groups expressed concern that the proposals were obviously unsustainable as plans unfolded. It was claimed, at the time, that there was no requirement to consult on structures so public views were not taken on board. Only a few short years later there is a realisation that the public had a point.
If you don’t engage the public in making plans you propagate the myth that health and social care is something that is done to people. You might be able to plan services without challenge from the public, they are not likely to be very good services. Please let’s try and avoid repeating the errors of the last major transformation of services.
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