Michael White on unaccountable PCTs

It happened this week, courtesy of Liberal Democrat MP John Pugh. I rang him because he caught my attention mid week. Just after a dull but cruel session of prime minister’s questions (dour Gordon Brown bullied by Dave “Flashman” Cameron) the MP rose to introduce a ten minute rule bill.

These decisions are made by enlightened quangos or trusts, and they are usually a combination of medical experts and appointees who may - or may not - bring relevant expertise

These bills, designed to draw attention to an issue, rarely become law and nowadays are rarely challenged unless they are particularly offensive or absurd. Pugh’s Local Health Service and Democratic Involvement Bill was neither.

In fact it was a slimline variant of official Lib Dem policy, which is to solve the problem of unaccountable primary care trusts by creating elected health boards - unlikely to happen whoever wins on 6 May.

Pugh’s starting point was that of an ex-councillor. Before being elected to succeed his colleague Ronnie Fearn as MP for Southport at the posh end of Merseyside, he was leader of local Sefton council. Both as a councillor and MP you get the chance to decide all sorts of things, he reminded the Commons. But local NHS decisions are not one of them - the “democratic deficit” is evident.

“These decisions are made by enlightened quangos or trusts, and they are usually a combination of medical experts and appointees who may - or may not - bring relevant expertise.” They have been “whisked humbly or smugly” into office by like-minded people, said Pugh.

Here we get to what lies behind the MP’s outrage - and to Plato. In the mid-noughties, Southport and Formby hospital lost services to Ormskirk district general hospital within the trust they share, a familiar process all over Britain.

What struck Pugh was that no amount of petition and protest could save children’s accident and emergency. Successive governments and NHS managers “work on the mistaken assumption that the general public are too stupid to notice they are powerless”. Sops like community health councils and the patients advice and liaison service or local involvement networks are powerless, too.

“It all goes back to Plato’s attack on democracy, the fundamental issue that people do not know what they are doing and will opt for popular but unworkable solutions,” explains Pugh - a philosopher by trade.

As such, ex-councillor Pugh realises that “if public opinion was asked if they want the NHS run by local authorities I know their answer” (ie, “no, thanks”). As for successive well meaning Commons bills he has worked on, “ministers will offer people consultation; the one thing they never give them is power”.

So what his little bill proposes is a modest trip wire to make PCTs more responsive.

Councils are not perfect, but - unlike trust and primary care trust chairs - they usually stick around to take the consequences of bad traffic or planning decisions. Unlike bad PCT decisions they rarely kill anyone.

Pugh’s bill would seek to bridge the current position and the ideal Lib Dem solution by requiring PCTs to lay their annual plans before the health scrutiny committee of the local council “for approval, agreement and amendment… a kind of democratic lock on the local NHS”.

There would be rows and the health secretary might have to arbitrate. All healthy stuff, says Pugh.

He has a point. By coincidence I noticed that during health question time his Lancashire colleague Paul Rowan was moaning about shortsighted closure of maternity units in Rochdale and Bury.