5. We are not convinced that the proposals to abolish Community Health Councils in England and establish new organisations that have been announced will improve on the current arrangements. We are glad to see that CHCs in Wales and local health councils in Scotland are not to be abolished. The new organisational arrangements to replace CHCs should ensure effective representation for each local community. We support the principles which ACHCEW set out for replacement bodies to CHCs, and we think it essential that such replacements be established and CHCs left in being until that happens. We would expect the Government to be responsive to the concerns already expressed.
6. We are concerned that the process to establish membership of Patients Forums should be transparent and have integrity. The process whereby members are selected or elected should be independent of the health service. It is not apparent how the selection mechanisms proposed will avoid perpetuating the institutional racism which pervades parts of the NHS. There are many groups who should be involved but unless real efforts are made the interests of prosperous articulate white people in reasonably good health are likely be higher on the agenda than those of people with different characteristics.
7. The proposal to establish Independent Local Advisory Forums in each Health Authority Area seems to have the potential to pull together some of these organisations into a more effective whole, but can only be effective if the members are wholly independent of the Health Authority, elected and accountable.
8. The NHS complaints procedure is in dire need of reform and we welcome the review which is taking place. In whatever new arrangements are made it is essential that both patients and service providers can benefit from skilled and independent advocates.
9. However effective scrutiny committees may be they cannot resolve the democratic deficit of the NHS. The scrutiny process will be very demanding. Local systems need to relate to those of the Commission for Health Improvement. Scrutiny should also cover private sector providers. Decisions in the NHS can be complex and many of the issues are difficult to understand. If local councils are to take on this demanding function there will be substantial resource implications. Members and officers will need to go and see for themselves what is happening in the NHS, and this cannot only happen during office hours. Scrutiny needs to cross organisational and geographical boundaries just as patients do. We suggest that scrutiny committees could co-opt additional members with appropriate expertise.
10. We do not see how one local authority scrutiny committee can possibly call to account all the NHS trusts which provide care for its residents nor how the Chief Executive of a large trust can possibly be accountable to all the local authorities from which its patients come. Both Trusts and local authorities may have differing interests.
13. Account must be taken of the size and complexity of the NHS to ensure managers and clinicians could deliver health and people outcomes effectively and in an accountable way. Recognition must be given to the distinctive roles of the DoH and NHSE. The NHS is far too centralised, financially driven and top down.
14. Staff are the most important resource of the NHS. They need to be valued ands managed in a way which encourages and develops their contribution to healthcare. Workforce planning should be instituted across all functions and made effective to ensure that the right people with appropriate skills are available when needed.
15. Staff training and development should be extended across all disciplines. There should be an NHS staff college to lead this work and develop the quality management the NHS needs.
16. Above is only a summary of the conclusions the Socialist Health Association has drawn from its conference and subsequent deliberations. We wish to take part in the consultations now to take place on the NHS Plan and the Health and Social Care Bill. We therefore seek a meeting with ministers to develop the discussions we had with the Labour Party Health Commission
Socialist Health Association 22/12/00
Principles agreed by conference workshop on accountability and the abolition of CHCs. The new arrangements must be: ·
Perceptibly independent of NHS providers ·
Accessible - geographically and culturally ·
An integrated service ·
With statutory rights to information - without any protection in respect of commercial confidentiality of any organisation proposing to undertake contracts with the NHS, to access to any premises from which care or treatment is delivered, and to be consulted about proposals for substantial changes in services ·
An evolutionary improvement on existing systems ·
Service wide, not confined to services provided by any one organisation ·
Enabling for individuals ·
Free at the point of use ·
People focussed ·
Representative ·
Locally responsive ·
Transparent, public, and accountable, particularly in the appointment process ·
Properly resourced, trained, and managed to quality standards ·
With a national body capable of drawing together experience across the whole country and ensuring consistent standards