Local people must have a say in NHS spending

At the time of writing, the NHS is racing ahead with the development of its new 10 year plan, based on additional funding announced in the summer. While we await publication, it is a good time to look ahead to what the new plan could bring, but to also reflect on the last NHS Plan from 2000, and its very different approaches to the public, the taxpayer and delivery of services.

The pillars of the last plan were certainly ambitious in their scope and approach, with previously unseen levels of investment, allied with a drive to improve and reform.

A better system

The government of the time made a case for investment in a better system, with 10 agreed principles signed up to by many organisations following extended, meaningful consultation. For the first time, quality and patient experience were very much in the mix, and crucially, there was hugely increased funding to match these ambitions.

Tellingly, the plan itself was signed not only by the secretary of state, but the prime minister himself. The message was clear – these were objectives driven from and endorsed by the very top of government.

Back at the turn of the millennium, the UK government was directly accountable for the NHS and people understood that. The centralised state basis for Bevan’s creation did not encourage local accountability – indeed, in many ways, it actually failed to countenance it.

At the moment we are in a situation where nobody knows who is accountable. This is simply not acceptable in a system which is bound up with so much public investment seeking to secure more

Since 2012, however, we have strayed into a situation where the NHS is one step removed from the government with decisions supposedly taken locally, but with no local accountability. There is also a worrying lack of scrutiny as to where taxpayers’ money is spent.

People will only continue to pay and support something they feel a part of and something which they have a level of influence over. Across the country, communities do not feel this way about the NHS as they once did. This fact alone should give government and NHS managers real cause for alarm.

As there are so many conflicting government priorities, and ever-increasing demands for funding from the Treasury, it is true that some MPs feel that the NHS gets special treatment whilst other departments are really struggling. This underlines the need for any additional funding to be well spent and the value of local communities understanding and really feeling the benefit of this investment.

So, what criteria should be used to plan for using a resource which we already know is insufficient for the many claims upon it? Our primary benchmark must be that the NHS should receive adequate funding to meet a set of clearly set objectives across the whole health and social care system for a given time period.

We need to be serious about what service we want to deliver, what we are prepared to pay for it and how it works for patients. The taxpayers and patients themselves must be able to influence the way the system works. But have they?

Parliamentary debate about the additional money has gone quiet. Meanwhile, local communities have simply not had the debate as to whether this is the best use of any additional funds when we see the state of local schools, cuts to Local Authority budgets or people coming to our surgeries at the sharp end of austerity.

At the moment we are in a situation where nobody knows who is accountable. This is simply not acceptable in a system which is bound up with so much public investment seeking to secure more. Obviously any additional funding is welcome but if the government is serious about supporting the NHS and social care for the long term they need to be clear on where the money is going and trust local people to have a say.