Democracy and Accountability in the new NHS 2001

1. This association welcomes the Government’s intention to improve democratic involvement in the NHS.


2. We note the resolution passed by Labour Party Conference in 1990 which reads in part: “Conference welcomes the commitment in the Labour Party Policy final report to the development of regional government. Conference supports elected regional government and sees it as a way of devolving power in the National Health Service and opening up the possibility of democratic accountability within the NHS.” We consider that this policy is still sound, has been effectively implemented in respect of Scotland and Wales and in London and we await proposals for the development of regional government in the rest of England.

Lay Members

3. We are concerned that despite recent improvements in the procedures for appointing non-executive directors to Trusts and Health Authorities and PCTs there is no clear description of the responsibilities of these posts. Mechanisms should be developed to enable these appointees to be accountable to their local communities. The best method would be for them to be elected rather than appointed. We welcome the proposals to elect a board member from the Patients Forum, but we suggest that electing two people, retiring in alternate years, would give continuity and a stronger voice.

Primary Care

4. Primary care is as important as hospital provision. As patients most of us most of the time are involved with primary care, not with hospitals. Mechanisms for accountability in primary care cannot be left entirely to the discretion of PCTs or clinicians, because those parts of the service which are unsatisfactory are those least likely to take action voluntarily. Accountability mechanisms in primary care need to be very local if people are to have any real involvement.

Patients and Citizens

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.

Public health

11. Local authorities make most of the decisions affecting the health of their populations. The Director of Public Health should be a joint appointment between Health and Local Authority to ensure more effective local health alliances as is done in Wales.


12. Audit is an important part of the accountability process but at present there are too many different bodies setting standards for Clinical Governance which are often not consistent. NICE might be the mechanism for co-ordinating these standards so there is less room for disagreement about what should be done and how it should be measured.

Organisation and management

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