We like to think that we own our NHS. It’s a public service. If we do own it, then the joke is on us. The NHS is now an unaccountable secretive mess and our interests are not being protected. The people tasked with looking after our interests are bullied or manipulated into amnesia.
We are supposed to have the most open and transparent health service in the world, pause here for prolonged laughter. What we have is a howling mess with providers behaving like autonomous private companies and claiming commercial confidentiality over everything; meeting in private to keep things secret.
We have CCGs that commission £billions of services but have no accountability to the public they serve and who keep their business as private as they can. They are even trying in some places, Staffordshire and Cambridge as examples, to evade all responsibility by transferring their responsibilities by contracting them out. The next wheeze might now be Accountable Care Organisations (that could be private companies) and which have no accountability yet hold long term contracts to plan commission and deliver NHS services. This is wrong.
We had the whole NHS being divided into 44 planning areas with Sustainability and Transformation Plans, making a brave attempt to overcome the chaos in the NHS caused by the dreadful Lansley Health and Social Care Act. Most of these STPs came out without any semblance of consultation with the public, patients or staff or even with the local authorities they were supposed to have included. Hardly a day goes by without some new idea for some new body yet none of them look like something we would be able to hold to account.
We have NHS bodies which are supposed to be public and which are paid through public funds behaving like the worst in the private sector. There was the legendary Strategic Projects Team spending years advising on half baked schemes to privatise services, all of which failed. The award winning SPT, set up initially to manage the Circle deal in Hinchingbrooke went from failure to failure but was never held to account. A proper record of what they did and on what authority will never be made public, good luck with any FoI request.
Now we have the new SPT – QE Facilities. Again, an NHS body, again with insider status, going around the country charging Trusts for advising them about how to evade VAT by setting up a wholly owned company. This publicly owned company has just refused an FoI request to list those Trusts it has spoken to. This is commercially confidential – we are not allowed to know if one part of the public sector has spoken to another part.
The saga of forming wholly owned companies to avoid VAT has been the latest stain on the NHS. Boards have gone down this route in secret, refusing to engage with the hundreds of staff involved – who will move out of the NHS. They make public claims about improving services which are wholly untrue – their own figures show all the savings come from tax changes and service improvement does not feature. They refuse to provide documents, meet in secret and refuse even to consult with their alleged partners in their local STP.
This behaviour by Foundation Trusts who do not even bother to involve their own Governors ( as they are not trusted) probably signals the end of the experiment with trying to get public bodies to behave like private companies.
These are the same Trusts that sign up to Sustainability (all the Transformation plan money has been nicked) Plans that are not sustainable and to control totals they know they have no chance of achieving. We live in the fantasy world where Boards are too weak to say no, they just play the game. Since almost every other Trust is in some kind of trouble retribution is unlikely.
Of course all this is in part a reaction to the absurdity that the legislative background is totally incoherent and is being largely ignored. Yes, there are examples of people coming together and trying to do their best for patients by trying new ways of working. All good. But none of this gets us anywhere unless we make the funding available to make sustainable changes possible. We get nowhere without decent workforce planning. We fail if we don’t address the yawning gap in accountability.
We will fail unless we get better Boards that tell the trust not just to power but to their own staff!
As waiting lists grow and cancellations increase satisfaction with the NHS is beginning to fall; more people are opting to spot purchase private care, the clear signs of a system in deep trouble.
So if we are the owners how do we get our say?