Tom Richmond: Why a truly radical NHS reform would bring increased power for the patients

It is why, purports Nick Clegg, voters will finally get their say next week over electoral reform.

It is why, argues Eric Pickles, people should directly elect mayors to run Yorkshire’s largest cities and have a greater say over contentious planning applications – hence the referendum against over-development in Menston, a community nestled in the shadow of Ilkley Moor.

And it is why, claims Theresa May, there should be police commissioners who are accountable to the concerns of the law-abiding public.

Yet, if the public deserve a far greater say over public and political functions, why are voters being excluded from exerting their influence, democratically, over the third largest employer in the world – the National Health Service?

If elected commissioners are right for the police, even though there are legitimate fears that those elected will be has-been politicians who have the potential to undermine the experience and wisdom of chief constables, why is this mantra not being extended to the NHS? It is a piece of illogical policy-making – increasingly symptomatic of the faltering Cameron coalition – as it tries to convince the public about the merits of devolving unprecedented financial powers to local GPs.

My doctors’ surgery in Leeds is supposed to be at the vanguard of this revolution. Visited by Gordon Brown during last year’s election, when managers had to kneel down on the floor to hold doors open for the then PM (which produced one of the more amusing campaign photographs), it is one of the supposedly super-surgeries favoured by politicians.

Yet I could not tell you the name of my GP any more because I see a different doctor whenever I make an appointment. There is none of the continuity of care that was, once, the bedrock of healthcare.

Equally perturbing is the booking system that is unfit for purpose. Appointments are only available if sufficient slots have been released in advance – despite Tony Blair promising to alter this in the 2005 election. These are for the convenience of GPs rather than the demand of patients.

Furthermore, one only establishes the availability of appointments by telephoning the surgery – and then waiting 30 minutes on an infernal call hold system. And don’t even think about complaining – a reply will not be forthcoming. Imagine what this will be like when these practices are responsible for budgets running into the tens of millions. Successive governments – Labour and Tory – have promised to end such sub-standard practices. Yet they persist. And now such surgeries – only accountable to their financial bottom line – will determine local health priorities.

Why should this be so? Don’t get me wrong. I do believe that the NHS needs reforming, and streamlining, to take account of an ageing population. I do also agree that too much money is squandered on bureaucracy and other unnecessary management processes. I also believe the role of all “front line” staff should be reviewed, including the number of growing clerical workers that sustain each hospital ward.

Yet, in my lifetime, every NHS shake-up has, effectively, ended in failure because politicians. and managers, instigate another set of changes after five years (or less) to justify their existence. The Cameron plan, dreamt up by the Health Secretary Andrew Lansley, will almost certainly suffer a similar fate when it is finally put out of its misery – whether it be now or after the next election. In short, it simply does not command the confidence of sufficient politicians, patients or healthcare professionals – the three most critical constituents of any health policy – because they, for varying reasons, do not altogether trust GP practices.

However, if local accountability is to be a coalition legacy, I see no reason why the existing primary care trusts cannot be radically slimmed down, and then headed by a health commissioner who is elected on a four-yearly basis.

There are several benefits to such a plan.

First, such an individual will be directly responsible for health performance in their area – and ensuring waiting time targets, and other local priorities such as access to life-extending cancer drugs for example, are adhered to.

Second, a health commissioner will be required to undertake a number of constituency surgeries which will make it much more straight-forward for residents to register their complaints.

Third, by aligning slimlined PCTs with council boundaries, there raises the prospect of a far more co-ordinated approach to improving public health – and tackling issues like care for the elderly that have a direct impact on both hospitals and local authorities.

And, finally, I do not believe that failed national or local politicians will be interested in becoming health professionals. There are sufficient healthcare professionals, or experts, who would relish the chance of improving the services.

This was borne out by Dr Richard Taylor’s protest against the closure of a Worcestershire A&E unit, which saw him become the Independent MP for Wyre Forest – and retain the seat until last year.

He was elected because he was trusted by the people. And that is the fundamental flaw with the Cameron and Lansley reforms. Patients, on the whole, have confidence in their GP on health matters.

They do not, however, believe that these individuals can combine their medical work with running an organisation as vast and bureaucratically top-heavy as the National Health Service.

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