Democracy in Health?


Do we need more democracy in health?

The NHS is a massive political football, kicked around by politicians and commentators as if it was one single thing. It is also the site of countless political battle grounds, between medical professionals, officials, managers, companies, charities, patients, the public and representative groups of all these interests in health. There will always be political battles over health, from national arguments over social factors, prevention and funding for services, to local arguments over the quality of care, food and treatment in a particular service.

This short presentation raises some questions about making health more democratic, at all levels. While the local level is most important, the national level sets the strategic framework and rules (the system conditions), so it focuses on the national level first with a proposal for a national stakeholder forum alongside the Health Select Committee of Parliament, because ultimately Parliament has the democratic authority and legitimacy to decide the rules.

This discussion is particularly relevant in the context of NHS’s England’s exploration of a “Civil Society Assembly” for the NHS.

There are enormous pressures on the NHS, both financial and political. The question is where and how these pressures will be dealt with, and how much of a say the public will have in the process, as patients, tax-payers and citizens. The following is one attempt at posing the question: comments welcome.

1.Public service, funded by taxes
2.Ownership of strategic framework – repeated reorganisation of the structure reflects the failure of the political system to come to terms with the NHS.  We.   need to get public agreement for the strategic direction, principles and framework for the NHS.  We have a constitution which was imposed rather than developed and owned through  public involvement, which also means it is relatively easy to change
3.NHS failures to hear patients
4.Too big for scrutiny by Parliament.  An economy as big as that of Turkey
5.Reconcile conflicting interests
6.Take difficult decisions
7.Produce better decisions for health
What do we mean by democracy in health?
What do we mean by democracy in health?

Stakeholder representation is about ensuring that everyone affected by something should have a say in the decision. So people with learning disabilities, special needs or chronic illnesses should also be able to take part in discussions and decisions that affect them as well as everyone else

Who has  voice & power in health?

Who has voice & power in health?

The new regime is top-down, CLICK
with patients and the public at the bottom, and the Secretary of the State at the top, accountable to Parliament.
In effect, an elected dictatorship or form of “democratic centralism”
I suggest we need to introduce democracy at three levels – services, local area and nationally.
First put patients & public at the top – I suggest doing this through a National Health stakeholder Forum

Set up Locally elected forums, either part of Local Authorities or extended Health and Well-being Board, with decision-making powers over all services including health
Then representative Boards for each Service as far as possible, including representatives of users and local communities

This may seem very tame, but it represents a very radical step which will be resisted by the Department for Health, NHS & Parliament
For this reason I propose it as a way of strengthening the role of Parliament and the Select Committee system
We could set up a stake holder forum, which I’d like to see become a ‘Parliament for Health’

Parliament for Health

There are various possible models for how membership is elected: one is that they would come up through HealthWatch, Patient Participation Groups and other local health forums and representative bodies.

Another model is to have a process for organisations to be recognised as constituent bodies and members of each section would initially be elected through those bodies, with representation reserved for different groups. In due course all members could be subject to elected by the public on the basis of EU constituencies, but still nominated by the constituent bodies.

Co-chairs of the forum would be members of Parliament, perhaps from either House. The whole forum would elect three or four co-chairs, with a stipulation that no party could have more than one co-chair.

The work of the Forum could be conducted in different ways, including participatory local or regional forums, working groups, online forums

Parliament for Health Powers:

1.Propose priorities for health
2.Hold NHS Board and strategic health bodies to account
3.Promote dialogue on critical issues
4.Recommend priorities for research and development
5.Run public consultations on health matters
6.Scrutinise WHO, Council of Health Ministers, etc;
7.Pre-legislative scrutiny of bills
8.Scrutinise and revise legislation through a “public reading stage”
9.Consensus building, where appropriate;
10.Advise on implementation;
11.Monitor implementation of policies affecting health;
12.Review and evaluate impact of legislation.
Local Health and Well-being Boards:

Health and wellbeing board

The big difference is that apart from Councillors, the Health & Wellbeing Boards are appointed and members of a Parliament for Health would be elected through their constituency groups