I have been performing my role as a lay member of the Durham Dales, Easington and Sedgefield Commissioning Group for just over a year now, so it is a good time to take stock as to whether the new system of public involvement in the NHS does involve the public more and better than happened in the past.
One thing is certain. Everything in the NHS is now much more open and transparent than it used to be. As Sir David Nicholson, Chief Executive of NHS England, recently remarked, there are not necessarily more failings now, it is just that we know about them because everything is out in the open.
But does that mean public involvement is better? I had a look at an article by Professor Bob Hudson on this subject. Professor Hudson is at Durham University, and has done a considerable amount of work about the NHS and advises local NHS bodies. He argues that there is a danger involvement can simply be “feedback” or even a form of market research to gain people’s opinions of how well services are performing. All very well, but not really an input into what the NHS does.
I have argued here before that if the NHS is to survive given increased demand and limited resources, some difficult choices have to be made. These will invariably be unpopular, so the public will have to be involved, and be part of the debate. People will resent it they are asked to agree to decisions which have already been made without knowing the reasons.
Professor Hudson argues there are two ways this can be done, what he calls “representative” and “participatory” governance. The first means giving far more control over the NHS to elected bodies, namely the local authority. The second would entail setting up a membership body, rather like the Foundation Trust for hospitals, which people join and then have a say in how the Commissioning Group is run.
The NHS already works far more closely with local government than it used to, so I am not sure that this approach would necessarily involve the public more. If we are to go for the “participatory” approach, then the NHS will have to put effort and resources into it. It is no good inviting people simply to come to a “talking shop” because if they think it is a waste of time most of them will not want to come. Issues must be explained, and people will have to feel their views and ideas are being listened to.
This approach will require time and effort, but as I have argued many times before, unless we take people with us we will not be able to deliver an NHS fit for the twentyfirst century. As the NHS Constitution says, “The NHS Belongs to the People”.
David Taylor-Gooby is a Lay member of the Durham Dales, Easington and Sedgefield Commissioning Group. He writes in a personal capacity. This article was first published in the Peterlee Star.