A Parliament for the NHS?

25^th February 2013

Titus Alexander responds to the Francis report with a radical proposal

The most fundamental issues raised by the Francis report on Mid-Staffordshire Hospital are not about the institutions or even culture, but about voice and power: who is heard, who is silenced and who, tragically, dies from deafness.

This issue was raised by earlier scandals at Alder Hey, the Bristol Royal Infirmary and Winterbourne View Hospital, but it was not addressed. It will arise again from inquiries into 14 or more hospitals announced recently. And it will arise yet again in the future unless we look at issues of voice and democratic accountability of health, because these issues cannot be answered by institutional measures alone.

As part of its response to the Francis report, the Government should consider creating a “Parliament for Health” to give representative organisations of patients, civil society and all other interests in health matters a voice at the highest level, above the bureaucracy of the Department for Health and the NHS Commissioning Board, to have a powerful voice in advising Parliament and the Minister on all health matters.

A few of Francis’s recommendations refer to patient participation on boards or inspections, the accountability of commissioners, the role of MPs and organisation of Local HealthWatch, but these do not address the lack of democratic accountability or scrutiny of national health policy. To address these questions, patients, carers and the public need a stronger voice at the frontline, where services are provided, and at the very top, where the design, priorities and funding of health provision is decided.

Our society’s problems with health are much wider than the leadership, management and organisational culture of the NHS. How services are run is just the most visible part of health care. As Matt Leach said in an earlier blog, the principal drivers of health outcomes are societal as much as institutional. The way we look after our own health, how we care for each, and how we manage health in the workplace or the food, drink, tobacco and other drugs we consume are more important for our physical and emotional well-being than health services. Each of these issues present problems more far-reaching than mismanagement at Mid-Staffordshire or other hospitals.

A solution to address these complex issues could be a “Health Policy Forum” or “Parliament of Health”, to strengthen democratic scrutiny and accountability of everything that affects health and connect the many different policy areas that influence our health. This should be an extension of Parliament rather than Whitehall or the NHS, so that it strengthens the role of health-related select committees and cannot be side-lined or silenced by the more powerful professionals who run health services.

It could be co-chaired by backbench MPs from health-related select committees and have statutory rights to discuss all legislation that affects health. It should be able to conduct investigations into the implementation of policy and report directly to the House of Commons through their co-chairs. It would discuss critical issues such as obesity, the impact of drugs or alcohol policy on health, NHS commissioning or the Francis report. It could take all consultation process on health matters from the NHS and Whitehall, and conduct pre-legislative scrutiny of bills before they are presented to the Commons, and monitor the implementation of all policies and legislation that affect health. It could hold the NHS Commissioning Board, Monitor and other strategic health bodies to account on behalf of Parliament (which should have the final say). It might even nominate members to the Boards of major NHS institutions and scrutinise the appointment of Chief Officers in the NHS. Above all, it should be a forum with the privileges of Parliament where any patient or member of staff or the public can bring their concerns about health matters.

The forum would include elected representatives of stakeholders concerned with different aspects of health, including patient groups, Local HealthWatch, staff, health researchers, civil society organisations and elected representatives from other tiers of government, including parish and local councillors and MEPs, with a majority from outside the health professions. Failures in the NHS are symptoms of the fact that Parliament does not have the capacity to exercise democratic oversight and accountability of health services. A Health Policy Forum would dramatically increase the knowledge and experience to inform health policy-making. It would be a permanent consultative body, with part-time members, elected for perhaps seven years, longer than a Parliament, to provide continuity and restraining advice on impatient Ministers determined to undo the work of a previous Government and leave their own mark. And if rapid change is necessary, it would enable Ministers to get it right first time and build consent among a majority of stakeholders in health.

To increase public access and participation, most of its work could be done through a mixture of working groups, open public meetings and online forums. It could conduct a “Public Reading Stage” of relevant legislation and meet to discuss major issues like those raised by Mid-Staff Hospital or contentious policy areas like addiction, obesity or hospital reorganisations.

An effective Health Policy Forum would be more challenging than the countless consultations, advisory groups and forums run by Whitehall and the NHS, but it could also be a place where issues are debated frankly and in depth, bringing a wider range of knowledge and experience to bear on policy decisions. It could make expensive inquiries like Healthcare for All, the Kennedy inquiry into deaths in Bristol Royal Infirmary, Winterbourne View or Mid-Staffordshire and many others unnecessary, because it would give people directly involved in health matters a powerful platform above the bureaucracies, linked directly to Parliament.

If the Government wants to address the deeper issues in health, it needs to look beyond the institutional matters raised by the Francis report and give the public, patients and professionals a forum to scrutinise everything that concerns health and wellbeing as an extension of the Select Committee system to strengthen our Parliamentary democracy.

For a more detailed discussion of what would it do and how it would work see ‘How would a Parliament for Health work?’ or email titus@democracymatters.info.