The views of Irwin Nash on the government’s recently launched NHS consultation
Many campaigners will react with despair and disappointment to Wes Streeting’s “consultation” on the future of our NHS. The shadow Health and Social Care Secretary, who studiously avoided any engagement with campaigners or health unions before the election, is unlikely to take any more notice of them now that he is Secretary of State.
Surely, we don’t need such a convoluted way of engaging with staff. It is much better to restore the idea of ‘partnership’ that has been thrown away—and it is obviously hard to engage with staff you have just privatised.
And many people will also be instantly put off by the inflexible and very limited scope for individuals to answer the preset questions.
Perhaps more important is whether anyone really believes that the replies will influence what gets decided. Wes Streeting has already set out what he sees as the three fundamentals of the latest promised “ten-year plan” before asking anyone what they think.
It includes what seems suspiciously like a re-run of Lord Darzi’s old 2007 idea of concentrating primary care and other services in ‘polyclinics’, now rebadged as “neighbourhood health centres,” even though Darzi himself no longer calls for them, and despite the fact these same ideas were rejected by the public as undesirable and by most of the NHS as unaffordable.
Of course, any individual views will be outweighed by the huge power of the vested interests—Foundation Trusts, Royal Colleges, and private providers—increasingly owned by hedge funds.
The underlying issues are too complex to be resolved by a barrage of individual opinions based on varying levels of knowledge and experience; the “consultation” will inevitably attract racist responses, conspiracy theories, rude suggestions on how to dispose of the Secretary of State, and heartfelt angry responses from the many who believe they or their loved ones have been let down. Plus endless sentimental wishes to return to some golden era that never was, when “matron” ruled the roost on the wards.
You have to laugh at the naivete of this consultation. After all, social care has had a multitude of studies, surveys, commissions, and reports—and it has just gotten progressive and disgracefully worse.
Surely, we don’t have to fill in a form online to say we want an NHS that works well for patients, that gets outcomes comparable with the best, and that treats everyone with respect and dignity. We want performance as good as 2010 and improvement to be even better. We want health inequalities addressed.
We can all nod to the three vague but worthy mantras – though we are now sick of hearing them. Tell us how. And when? Show us the money? Meanwhile, what will ministers do now to tackle the looming winter crisis in emergency services and the chronic shortfall in mental health care?
What we have is indeed a failing system, and there is a dire and urgent need to fix quite a few immediate issues as well as a long-term plan. We would like to believe that things will get better soon, that staff are treated well, and that we have an NHS system run by competent people who genuinely care.
Of course, we want the NHS to remain free at the point of need, universal, comprehensive, and funded from general taxation—that system works as well as or better than any alternative. Where those four pillars have been eroded, for example, by restrictions on access or charges, we want that reversed.
The biggest change most want is for the NHS and all its component parts to also be open, transparent, and accountable to us. We want an end to NHS organisations pretending they are businesses and making decisions in secret, refusing to even publish their reasons.
We want to be clear about what is decided nationally (for example, our entitlement to services, the pay and conditions of staff and even national service frameworks and national targets.)
But we also want devolution and flexibility for service delivery to be tailored to local circumstances—and to do this, reverse the inequality of the inverse care law.
Top-down management by shouting at people has had its day.
We want a system run as a public service, not the chaos of a market. So, where the NHS has to buy goods or services from outside the NHS, we want to know why and be satisfied that is the best decision for patients, not to boost the profits of some company or hedge fund.
We want investment in the NHS, not outsourcing.
We would also much prefer an NHS that is joined up to the rest of the public service. An NHS plan without a social care plan is daft, and a social care system based on means testing, which has been delivered almost entirely by the private sector for the last 30 years, will need a lot of change to fit into a proper care system. The answer to that is bold action, not ‘cross-party talks’.
Is that so hard to understand?
We have a new government with a big majority and an army of civil servants across the Department, NHS England and all the many outposts. Tell them to get on with it.
* You can share your experiences, views and ideas for fixing the NHS via the Change NHS online platform, which will be live until the start of next year, and available via the NHS App.
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