It seems like only yesterday that I was working in the NHS, leading a group of GP commissioners preparing for the Health and Social Care Act 2012 and, every year, preparing for winter. Such was my experience of preparing for that Act that it led to my giving up my day job and deciding to become an elected politician and to enter this House. My colleagues at the time said to me, “Try to bring some sense to the debate going on, which is often so ill informed.” Today, we have heard some very well informed contributions, and I hope to offer some prospect of moving forward.
I want to talk about the 2012 Act. Its purpose was to modernise and avoid a future crisis, as well as to put clinicians at the centre of commissioning, free up providers to innovate, empower patients and give a new focus to public health, and it has categorically failed on all counts. Does the Act matter to patients? All reorganisations take people’s eye off the ball, but this one has been in an altogether different league. Long-standing problems have persisted and necessary changes have been put on hold as managers try to put back the infrastructure that was so wantonly destroyed by the Act.
In my constituency, South Bristol Community Hospital, a long-awaited community hospital, serves an area of very high health need. It is intended to support those with chronic illness in the community and to work with GPs, as well as to provide an urgent care centre and access to therapies. Much has been achieved by those on the frontline in the hospital, but it falls between five NHS bodies.
This week, a constituent highlighted a problem after she was told that her appointment had been cancelled because the person it was with was no longer in post. She persevered with the booking, but it was not possible to tell her whether another appointment would be forthcoming. I have taken the matter up on her behalf, but I have to write to three different people to try to find an answer. Colleagues know that that is the situation across the piece.
No one body is assessing health needs, talking to the local population and ensuring that services meet those needs and are reversing health inequalities, so how do we move forward? My strong view is that we need to talk about not only the money, which is very important, but the superstructures. We are at a critical point. We have had centralised planning and control. It did not work, ultimately, and the era of the market and competition is also not working. We need now to put accountability at the very heart of the system.
Accountability can be a key driver of change and improvement, and it is vital in a functioning democracy. All the bodies involved spend taxpayers’ money, but no one understands who is responsible and who is accountable for how they spend that money. That includes us in the House; we are also mystified.
Local MPs are expected by their constituents to stand up for local services, ensuring that there are enough resources, and to be able to make a difference when things go wrong, but we have no role locally in how the mandate is delivered or in the alignment of the voted national budget with local delivery. Critically, neither do local people. They do not understand how their national taxes relate to the local service.
We are pivotal in helping with that understanding. Local managers should be supported in sharing the great work that they do, but they also need to share the realities of cost and quality with MPs and local people so that we are all well informed. However, that will happen only if national leaders are supported when they fulfil their duty of candour and speak out about the reality of choices, which national leaders have done.
It is no secret that the money the NHS is allocated is insufficient to do all that is promised in the NHS constitution, to the quality that we expect. It is also well evidenced that we have the most effective and efficient service in the world, with productivity outstripping other sectors of our economy. So on behalf of our constituents, we should be putting the public centre stage, considering how to actively improve the NHS and understanding what the money can deliver. We have to give patients and the public genuine influence over decisions affecting the care that they, their families and their communities receive, and the responsibility that goes with that influence.
Being able to follow the money is a key part of accountability. We should all be part of that to help to inform the next stage in the development of the NHS.