On Friday I went along to a meeting of local residents who are concerned about the NHS reforms and how they might affect services here in Sutton. The campaign organisation 38 Degrees had called on their members to form such groups to monitor new Clinical Commissioning Groups, consortia of local doctors who are due to take over the role of their local Primary Care Trust (PCT) especially in where you might be sent for further treatment. The Sutton Clinical Commissioning Group consists of 28 local GP practices led by local GP and former councillor, Dr Brendan Hudson.
Although there were only 7 residents there, these types of groups usually grow slowly. However what quickly became clear is the different concerns and angles that members had which will be difficult to manage in defining a role. It is how this is managed that determines how effective local decision making will be. In a discussion about defining the group’s role, the key matter of ensuring quality is not overlooked in favour of cost was touched on but needs to be at the top of the agenda. Much of the discussion centred on ensuring that the NHS was not privatised. Since there is no question of this happening through the reforms the risk is that people will concentrate on the politics of the NHS rather than the delivery of effective services.
As one might expect I am in favour of the reforms. Although they haven’t eliminated the alphabet soup of acronyms in the NHS they will bring decision making to GPs and patients rather than Whitehall mandarins. For this reason I see the changes as bottom-up reforms rather than top-down that is often trotted out by the Labour Party. I am not sad to see the end of PCTs having seen first-hand how much money is wasted when I was on the Project Board overseeing the rebuilding of Stanley Park High School in Carshalton. Bureaucracy and intransigence saw delays that resulted in our local PCT ending up with less money for the sale of Queen Mary’s Hospital where the school was built and eye-watering legal fees between two taxpayer-funded bodies, them and Sutton Council.
The use of private contractors in the Health Service is nothing new. Your GP is not and has never been an NHS employee. They are private practioners usually fully funded from public funds unless they do additional private work. The key is how they are contracted. The same is true for private contractors in other areas from cleaning hospitals to adding capacity in some treatments. If the tender contract is drafted well building quality and accountability into the specification and the contractor is managed well, there should be no reason why a private contractor cannot provide at least the same quality as in-house provision.
This leaves the question as to what should the role of groups like the local 38 degrees residents be. The NHS is notoriously complex. It is hugely difficult to scrutinise well. Residents taking an interest in any part of the service will ensure that there is greater transparency and accountability. That won’t be immediate. Residents need to know where to look, how to understand the jargon and the weblike structure that remains but it is important that they start to get involved. We have seen what happens otherwise. The one good thing about the Better Services, Better Value review was that it is being done locally. The terrible thing about it is that it is not being done openly with members of the public being able to see the decision making process and influencing it at an early stage. We need more residents to become interested and involved so the community isn’t always reacting to what is being done to them, but instead is responding to improvements that are being introduced with them.