David Cameron is on the Today programme banging on about making the NHS more patient-centred and suggesting regular patient-led hospital inspections to ensure that this is the case.
Nothing wrong with this in principle. Indeed, every successive Prime Minister and Health Secretary in the last sixty years has talked about “putting the patient at the heart of the NHS” or some such soundbite. Equally, patient-led inspections are an important tool to support such an aspiration. Indeed, when I was Director of the Association of Community Health Councils in the late-1980s and through much of the 1990s, I was well aware of the importance of unannounced CHC inspections in promoting improvements in patient care at local level and in highlighting wider issues of health policy.
But – and it is a big but – the Government’s proposals for local HealthWatch organisations still fall a long way short of guaranteeing the network of vibrant independent patient-led structures that CHCs (shamefully abolished by the last Labour Government) provided in their hey-day. There are two big problems with the Government’s ideas on this in the Health and Social Care Bill, currently paused in its long slow grind through the House of Lords.
First, the new local HealthWatch organisations will be creatures of the local authorities in their areas, even though they will be expected to monitor the social care provisions commissioned and provided by those same local councils. Hardly, independent.
And the national structure, HealthWatch England, will be packed with Secretary of State appointees and will be a creature of the Care Quality Commission (constituted as a CQC Sub-Committee), even though much of the work of HealthWatch may involve calling on the CQC to take action on specific matters and may require criticism of the effectiveness of the CQC itself as a regulator (hardly easy if you rely on that body for all your support services).
And second, the system is likely to be grossly under-resourced. The Government is planning to “provide” resources for the new local HealthWatch organisations as part of their general grant to local Councils. No ring-fenced money. And, at a time when local government is having to make very substantial cuts in their core provision, it is hard to see that this will be much of a priority in any local council’s deliberations. The evidence in the last year of the way in which the budgets of Local Involvement Networks (LINks – the current iteration of the Department of Health’s attempts to replace CHCs) have been cut – in some instances by as much as 70 or 80% by local councils – does not provide much hope for properly-funded local HealthWatch organisations in the future (especially when they start criticising that council’s own provision).
And, of course, with so much of health and social care taking place outside a hospital setting, the Prime Minister’s comments do suggest a mindset locked in the concept of an NHS that is all about hospital/acute care . Delivering patient-centred community-based care will require both a willingness to invest properly and sustainably in those aspects of the NHS and also a recognition that patient-led monitoring of those services is not only important too but will also need to be resourced properly.
Without any of that, the Prime Minister’s comments today are nothing but empty soundbites. So, no surprise there …