NHS Activism

The Health and Social Care Bill has almost passed. There will be quite a few government MPs who will rue this day since every possible ill in the NHS will now be pinned on them for passing a Bill that no one wanted. Protecting our NHS is not achieved through marches or clicktivism (e-petitions or the like) it can only be carried out through getting involved. Here are five ways you can do that (inspired by Martin Rathfelder):

1) Foundation Trust members and Governors

All NHS acute and mental hospital trusts will have to be a Foundation Trust, or part of a Foundation Trust, by April 2014. (The only exception is Hinchingbrooke, and there is a clause specifically for this "franchise" in the Bill.)

Foundation Trusts are supposed to be run for the community. At the moment - and to a large extent - FTs only play lip service to the community. You can, however, change this by getting involved and becoming a member. First, you have to be over 16. Second, you have to live in the catchment area of the FT. The trust will define what "catchment" means. Some FTs are local, but others have national, or sub-national, memberships, so check all the trusts local to you about their membership and join all you can. Socialist Health Association have collated a list of Foundation Trusts that have a national membership. 

As a member you will be able to speak at members meetings and the trust will have other mechanisms for you to get involved (as a member, you'll be informed what these are, the trust must have a patient engagement policy). When the Bill is passed you will also be able to attend trust board meetings, which means that you'll be able to ask the board questions.

Members can also stand to be governors. The Council of Governors will have some appointed governors, but the majority have to be elected. Governors have to approve the trust strategy and appoint the auditors. They also appoint non-executive directors (NEDs, including the Chair of the trust) who sit on the trust board. NEDs are accountable to governors and have to justify their actions to the Council of Governors. The government says that before an FT can increase its private patient income over 5% it has to have the approval of the Council of Governors. However, governors should monitor the trust's finances carefully and they should know if private patient income is increasing and challenge the board to guarantee that NHS patients are not affected.

Action: Join an FT, stand to be a governor as the NHS candidate.

2) Health and Wellbeing Boards

If you are a councillor (district, county or unitary) then stand to be a member of the local Health and Wellbeing Board. The HWB will be able to challenge local commissioners (Clinical Commissioning Groups - CCGs) on their commissioning decisions, including those that involve transferring NHS services to private companies.

If you intend to stand for election this May, then in your election leaflets indicate that if elected you will stand to be on the HWB as the NHS candidate, and that you'll use this position to protect your local NHS facilities. When you are elected, and should you get on the HWB, you will have a mandate to ensure that the local CCGs use NHS providers.

Action: Stand as the NHS candidate in council elections, put yourself forward to sit on the council's HWB.

3) HealthWatch

HealthWatch are local organisations with a mandate to inspect local health and social care services. Local HealthWatch will be hosted by local councils and will be largely toothless. However, HW will put together reports on local services, which can be escalated to the national HealthWatch and CQC (Care Quality Commission). A HW member will also sit on the local HWB and can challenge commissioning decisions.

The toothless nature of HW is disappointing. However, what will be significant is that HW will have a mandate to inspect all providers which means that within HW there will be an immense amount of knowledge. This means that HW will be significant and influential in an advisory role (in particular, in advising local authorities).

Action: Approach your local council and inquire about joining HealthWatch.

4) Patient Involvement

The Bill says that there has to be patient involvement in commissioning. You will find that your local GP will have a patient participation group (if not, then it will have very soon). This will enable you to be involved in the delivery of care at the GP: for example, you'll be able to challenge the GP about surgery times or access to the surgery. The actual commissioning decisions will be carried out by the CCG, but you may find that the GP group will give you access to the CCG patient involvement group.

CCGs have to have a policy on patient involvement. Right now, pathfinder CCGs will be formulating these policies, so approach your local CCG and ask about what patient consultation they are carrying out, and ask to be involved. If you are involved in the formulation of the CCG policy you can ensure that patients are consulted at all stages, on all commissioning decisions. This is important because it means that patients could be involved early-on in the decision making so that if the CCG decides to use the private sector a patient involved in commissioning could make this public and spark a local debate. Further, you should also ensure that the CCG board have a regard to patient involvement (for example, mandatory attendance of patient groups) and have a defined route for patients to raise concerns to the board level.

Action: Approach your local CCG and ask about patient involvement in the CCG. Use this to challenge the CCG on their commissioning decisions when they use the private sector.

5) Non-executive Directors

Foundation Trusts and CCGs will have non-executive or lay members. In the case of FTs non-executive directors will be appointed by the governors; in the case of CCGs lay members of the board will be appointed by the CCG. The role of non-execs (NEDs) is to hold the executive board to account and to provide an independent voice on the board. In general, NEDs will be professionals: people with experience of running a business or a large public organisation, or have a professional involvement like law or accountancy. The role is part-time (a few days a month) and usually pays just a small salary. However, as a NED or lay member you will be able to scrutinise the boards decisions, and challenge them if the board intend to use the private sector.

Action: keep an eye on local adverts for positions of Non-Executive Director of the local FT or as a lay member of the local CCG board.