Don Redding: give the public remote control
To create a mandate for the commissioning board that truly belongs to the public, the government should take a cue from the BBC.
“The NHS belongs to the people.” That is the declaration in the first line of the NHS constitution, which the NHS Commissioning Board will be legally bound to uphold. It is logical, then, for the mandate to that board also to belong to the people.
The mandate, now in preparation, risks being either a dry legal document or a technical specification, or some uneasy conflation of the two. The fact that it will be accompanied by a framework agreement, a sort of service level contract, creates an opportunity to do something different in the main piece - to create a wording which patients and the public can read and understand in terms that make sense to us.
What is the deal that our government, on our behalf, is striking with this powerful new quango? After 18 months of puzzlement, polemics, pauses and politicking around the Health Act, we have a pressing need to know.
The prime minister and health secretary declared the reforms would mean patients could make joined-up care planning decisions with our trusted professionals. It is this sort of proposition we might want to see on the face of the mandate.
There is some useful precedent from the BBC, the nearest comparable public institution to the NHS. In 2004, as the government began preparing for a new BBC charter, it realised that all previous versions had said little about what the corporation was for. The only line about its mission was “to inform, educate and entertain”.
The current charter, in force since 2006, changed that. At the top is a statement of seven “purposes” which the BBC undertook to deliver on behalf of the nation. These “main objects” of the BBC were part of a public consultation. They include sustaining citizenship and civil society, promoting education and learning, stimulating creativity and cultural excellence and representing the UK, its nations, regions and communities.
The means by which it carries out these “purposes” are then elaborated in the agreement. Each of the BBC’s services must set out a “remit” showing how it meets the purposes. These remits are regularly reviewed, including through further public consultation.
There is no easy parallel to the NHS Commissioning Board, however. The board is already replete with a host of duties and responsibilities laid down in law, which might be equivalent to the BBC “purposes”: improving healthcare quality, reducing inequalities, guaranteeing patient choice, and ensuring patients are involved in their diagnosis, care and treatment.
Don Redding is director of policy at National Voices.