"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Thursday, 11 July 2013

Patient in Chief

One of the principal aims of the Health and Social Care Act 2012 was to remove the responsibility from the Secretary of State for the provision of NHS services. Lansley's "great idea" was that NHS England (the country's largest ever Quango) runs the NHS and once a year the Secretary of State hands them a list of instructions ("the mandate") for them to fulfil in the following year. However, few believe that is could be possible, certainly not in the short term. In the Fifth Report on Commissioning, Stephen Dorrell, the Chair of the Health select Committee said:
Voters will, however, rightly continue to regard the Secretary of State as accountable for the development of the NHS—there can and should be no doubt that ultimate responsibility rests with him. The Government must therefore put in place structures which enable the Secretary of State to respond to this political reality.
Inspite of the warnings that it is not possible for the Secretary of State to abrogate responsibility for the NHS, Jeremy Hunt and his lieutenants have tried hard to make it a reality. (For example, recently Anna Soubry, the Minister of State with nominal responsibility for cancer care, refused to answer questions from MPs telling them they have to ask NHS England and not her.)

Hunt has clearly decided to appoint himself the "patient-in-chief". However, in Hunt's rarified environment of Westminster politicians, hacks and wonks, his idea of a "patient-in-chief" is to spend all his time complaining about the NHS rather than taking actions to improve it. It's as if Hunt has become the personification of a Daily Mail article: the NHS is no longer his responsibility, it's someone else's problem.

It has always been a responsibility of Secretary of States to be seen in the NHS, mostly visiting hospitals for pictures alongside smiling patients. During the passage of the Health and Social Care Act the Labour Party needed to get publicity and to get the Press (who appeared to have had some kind of D-notice imposed on them about anything to do with healthcare) to report something about the party and their NHS policy. Labour came up with a idea where their health spokespeople would "shadow" people working in the NHS: GPs, consultants, nurses, porters. These gave valuable photo opportunities, and allowed Labour politicians to talk to the Press about their experiences. It was a bit of a gimmick, but one that was desperately needed considering the Press refused to report anything about NHS policy.

Hunt, a man who has never been known to have an original idea, has co-opted this policy. In April it was announced that the Secretary of State would
deliver care "in some capacity" and would be carrying out cleaning and portering duties while observing clinical care given to patients.
at Watford General Hospital's emergency department. This, we were told, was "part of a back to the floor experience". However, it was just PR. While Labour could be excused the PR gimmick because they were starved the access to the Press, Hunt does not need to do this.

Cleaning and portering duties on one occasion does not make Hunt realise what it is like to be a cleaner or porter. Hunt has a ministerial phone and it was understood that if the PM phoned him (even for legitimate reasons - like say a national crisis) then Hunt would immediately return to London. An NHS worker cannot do this, none are expendable, if they leave unexpectedly patient care is affected; Hunt knew that he was in addition to the staff needed so if he left unexpectedly the care would be just the same. Hunt was not earning an NHS wage, and after his shift did not have to go back to the bills and debts of a porter's wage. Even the aim to "observe clinical care" was phoney: it is inconceivable that the trust would not have put on a special effort during the day that the Secretary of State was visiting. It is also inconsistent. Hunt is modelling himself as the "patient-in-chief" so what does he do? He pretends to be an NHS worker!

Hunt should stop these "work experience" pantomimes. They serve no useful purpose: he neither experiences how it is to do the job, nor what it is like to be a patient. Moreover, they appear phoney and hence are counter-productive.

If he is serious about being the "patient-in-chief" then Hunt has to become a patient and see the NHS like we do. I am not suggesting that he becomes ill (I would never wish that upon anyone) but there are more effective ways to see how the NHS performs than by pretending he is a porter. When Andrew Adonis became transport minister in 2009 he prepare himself by travelling on every mainline railway, this way he could experience the rail system like a passenger and learn about where improvements should be made. Hunt should learn from this: he can be a patient without being ill.

What he needs to do is become a patient activist. To justify its uncalled-for reforms the government made a big announcement that the NHS would work by the principle of "no decision about me without me". The Lansley reforms added new structures to do this in addition to the existing patient participation opportunities. This is how Hunt can experience the NHS from the patient's perspective.
  1. He should attend the Foundation Trust governors' meeting of his local trust. This is not a huge obligation from him, they have to be held four times a year and are usually half day meetings. At the governors' meeting he can hear about the concerns from patient representatives about the quality and patient experience at the trust. He will also see the effect of cuts in tariff and the increasing numbers of fines have on the smooth running of the trust.
  2. He should attend local Healthwatch public meetings. These are not statutory and the policies of Healthwatch vary across the country, but Hunt should attempt to attend as many as he can for his local organisation. Healthwatch should know where the local problems are. If he attends his FT meetings then he can put Healthwatch concerns in perspective with the challenges that the FT has to overcome. This should allow Hunt to adjust his policies to improve the NHS in general. If his local Healthwatch are not reporting local issues then this is a failure and he should change his policies to enable them.
  3. He should attend his local CCG's patient reference group. These vary across the country, but every CCG had to have some form of patient involvement in commissioning as part of authorisation. Hunt should attend his local group regularly - possibly once a month or every other month. This will allow him to see from the CCG's perspective the difficulty they have in providing services when faced with NHS cuts. He will also see how the relationships between GP commissioners and NHS providers are developing and see the effect of procurement law on the delivery of services.
  4. He should attend his local GP's patient reference group. Again, this is not a huge obligation: an hour or so every other month. This will allow him to see the concerns of GPs and their patients. 
  5. If he has some extra time (perhaps by cancelling some of his dancing lessons) he should attend his local Health and Wellbeing Board (every other month, 2 or 3 hours) so that he can determine for himself whether the board is effective.
The important point is that he does not do these things once. At a minimum he should do these things for at least a year. Since these meetings will be attended mostly by patients (or in some cases, run by patients) he would be able to see what actual patient concerns are (hint: in my experience as a "patient activist" no one has ever mentioned immigrant's use of the NHS, it is not a patient concern).

Hunt: stop the work experience and become a patient activist.

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