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
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
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
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 email@example.com.