This week: Part two of our in-depth interview with Dr Sarah Wollaston, focusing on her role as the chair of the Commons health and social care committee. Part one is here.
This week: Part two of our in-depth interview with Dr Sarah Wollaston, focusing on her role as the chair of the Commons health and social care committee. Part one is here.
Why the health select committee matters: During the New Labour years the size of the government majority made the committee an irritant at best. However, this decade’s political turmoil - along with some new rules increasing select committees’ influence - has handed a central role to the committee to address issues the government was avoiding or downplaying. Under the leadership of, first, Stephen Dorrell and then of Dr Wollaston since 2015, its deliberations have swayed the debate and, in some cases, produced changes of heart from government.
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How do you break a political logjam? No, not Brexit – some problems have no logical answers – but the need to give the emerging integrated care systems the statutory backing they need to take control.
The government asked for ideas for legislative reform to be included in the immenient NHS Long Term Plan – which they duly will.
However, the temptation for Labour and peers from all parties to load the legislation with amendments could be irresistible. With parliamentary time ultra-tight for the foreseeable future, the government has signalled that any attempt to ‘Christmas tree’ the legislation – especially where amendments add cost – would lead to any bill being swiftly abandoned.
Could the Health and Social Care Committee act as the honest broker that is so clearly needed?
Dr Wollaston reveals she has suggested the soon to be created NHS Assembly examine the reforms recommended in the Long-Term Plan and present the committee with the legislative changes they would like to see.
“We’ll then conduct the pre-legislative scrutiny and then hand it over to the government to take through the Commons,” she explains.
Mission creep
Recognising that the legislation will be “deeply political”, she adds that to have any chance of success it must combine a clear ask from the NHS with some cross-party support from the moment “it arrives on the floor of the house”.
NHS England and the government have yet to accept Dr Wollaston’s kind offer – it is likely they fear such a process might produce the kind of mission creep they are desperate to avoid.
But whatever, the route taken to bring legislation forward, the health select committee chair wants them to learn the lessons of both the 2012 Health and Social Care Act and original iteration of local STP plans and involve the end users of the service from beginning.
“We just tend to get completely obsessed with talking about systems” and end up with proposals for integration which “mean nothing to anybody”. Better, she declares, “to start with the patient and work back from there”.
Scold and embarrass
She wants any consultation on the proposals to “go back to those organisations closest to the patient” ask “what’s getting in the way” of integrated care?
She suggest one likely answer: “What we hear time and again is it that you have too many bodies… [which] gets in the way of collaborative working…Instead of thinking about it as a healthcare pound or a social care pound or an NHS pound, we could just say actually it’s a patient pound, how are we going to make that pound work better for everybody?”
’I genuinely think you can get more out of witnesses if you’re not haranguing them because it can just make people defensive. When did you last change your mind because somebody was haranguing you?’
Unlike many select committee chairs of the past, Dr Wollaston thinks it is more important to help public and civil servants find solutions than it is to scold and embarrass them.
“I genuinely think you can get more out of witnesses if you’re not haranguing them because it can just make people defensive. When did you last change your mind because somebody was haranguing you?”
Not that Dr Wollaston is afraid of “being quite combative” when required, recalling particularly bruising encounters with Sarah Wilkinson and Duncan Selbie, the chief executives of NHS Digital and Public Health England respectively.
Holding to account
Dr Wollaston says the committee is often wrongly perceived as a branch of government by the public.
“We’re there to hold government to account. The good thing about select committees is that we have a cross party group of MPs trying to work constructively together, representing the public on an area of policy that is so central to people’s lives.
“Of course, it’s more than holding to account. It’s also about trying to look at areas of developing public policy and maybe have an influence on its direction. Sometimes it might be looking at something that’s fallen off the government’s agenda.”
A case in point is the committee recent inquiry into antimicrobial resistance. This came about after England’s chief medical officer Dame Sally Davies told the committee chair it “should be a top five policy priority”, but that since the departure of David Cameron it was no longer getting the attention it deserved from the government.
“Sometimes,” continues Dr Wollaston, the committee’s work involves “looking at very specific issues like, for example, preventing suicide and trying to…get all government departments to take an interest in [a subject that] goes far beyond a single department.”
There is also the committee’s role in reviewing the appointment of senior NHS figures. Its views can be ignored - and sometimes are – but usually the interviewees are keen to avoid the committee’s censure. Dr Wollaston says, for example, that she is “very pleased” that new NHS England chair Lord Prior accepted the committee’s recommendation to drop the party whip.
NHS Digital should have been there fighting for the confidentiality of patients and was far too quick to roll over to pressure from the Home Office
Asked what other successes she is proud of, she cites the government’s decision to review the sharing of confidential patient information with the Home Office (a story broken by HSJ, of course).
Dr Wollaston says the committee considered the policy “egregious’ and pursued NHS Digital “doggedly”, until we “persuaded the government to come to the dispatch box and say that they would go back to the drawing board”.
She continues: “It was absolutely vital that we established that the confidentiality of medical records is an overriding responsibility and you can’t have different standards applied by the NHS and by the GMC to what’s being applied by NHS Digital. NHS Digital should have been there fighting for the confidentiality of patients and was far too quick to roll over to pressure from the Home Office.”
Sticking plaster
She also expresses satisfaction that the committee were able to persuade Public Health England to publish its report on the impact of sugar. “We knew that was very important to have that in the public domain if we were going to build the argument for having a sugary drinks levy”, she adds.
Then there is the committee’s work in bringing care quality issues into the light.
The day on which HSJ interviewed the health select committee chair coincided with the publication of its report on the shocking state of prison healthcare.
One of the drivers for that inquiry came from conversation the Totnes MP had with someone whose grandson had died by suicide while a prisoner. It is these kinds of discussions that “gets you thinking about some of the wider background issues”, she says.
Much of the committee’s work is designed to influence policy over the long-term.
This is particularly the case on increasing the funding for health and social care, where Dr Wollaston says the committee has been “relentlessly arguing the case, hearing and publishing the evidence for the case for long term sustainable funding, not just short term and sticking plaster responses”.
This goes double for social care funding and reform where Dr Wollaston is once again trying to “build the case with constructive cross party working for actually getting a solution to one of the biggest challenges of our age”.
On this issue it is her majesty’s opposition which has earned her disapproval. She says the Labour front bench have refused to engage with the committee’s calls for a cross party approach to the problem.
“I think it’s really unfortunate they’re not coming on board because otherwise we are going to have the same conversations in five years’ time with [social care reform] being [labelled] a dementia or death tax. Every time one party comes up with something the other parties trash it for political gain. Well, the public is sick of that.”
Dr Wollaston says she works hard to develop a consensus from the committee’s deliberations.
“I don’t think of it as being my committee. I think you must have cross party consensus in a committee for it to work properly and if it just looks like a single individual is just taking over you’re less likely to get people working in it in a consensual cross-party way. And I think that’s how select committees are at their best.
Next week: Armed forces champion Johnny Mercer MP
Coming up: SNP health spokeswoman Dr Philippa Whitford; and Jeremy Heywood: an appreciation
If there is any political figure you would like me to interview, please email alastair.mclellan@wilmingtonhealthcare.com or if you are reading this on the website leave them in the comments box.
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