Battle for Grantham Hospital Continues

29 November 2006

The battle for Grantham Hospital continues. I have two important meetings, with the Primary Care Trust and the Hospitals Trust, next week. I doubt, however, I will have news – positive or negative – to report before Christmas.

But over the past months a growing conviction has emerged in my own mind. It is that the way decisions are taken in the N.H.S. is quite inconsistent with our self-image as a modern, open, participatory democracy.

We have created a bureaucratic monster, theoretically at least, responsible to a minister – the Secretary of State – who is theoretically responsible to Parliament. In practice, the monster has acquired an inscrutable and uncontrollable momentum of its own.

The Secretary of State appoints an N.H.S. Board, who appoint bureaucrats in Whitehall, who appoint Strategic Health Authorities (ours is in Nottingham) who appoint the boards of Primary Care Trusts and Hospital Trusts. The latter are supposed to be in independent juxtaposition as respectively “commissioners” and competitive “providers” of health services. In fact the careers of the managers and employees of both Trusts depend on pleasing the same “Strategic Health Authority” which appointed (and can dismiss or demote) all of them. Satisfying the patient (or the patient’s GP) is quite irrelevant. To survive, you simply have to keep your boss in the bureaucracy happy.

In such a system, if ministers want to absolve themselves of responsibility, they can readily say they have to follow the recommendations of those who know the local circumstances. Local bureaucrats can plead they are only following the directions of their superiors, or the consequences of budgetary constraints.
No-one outside the process can readily influence it, least of all the customers – actual and potential patients. Imagine a car manufacturer - or supermarket chain - the careers of whose managers and staff had nothing to do with the satisfaction of customers.

What is the solution? It is radical and I have so far failed to sell it to either major political party – but I will certainly try.

It must be the funding of local health boards, call them P.C.T.s if you must, on a block grant basis from central government (according to population, average age and “morbidity” or incidence of disease) and the public democratic local election of these boards (like school boards in the U.S.) who would then decide how to allocate the money and be directly accountable for doing so.