As party conference season comes to a close, taking politics out of the NHS may seem desirable, but that could be the wrong direction entirely, says Sean Duggan
“Take politics out of the NHS” is something often heard uttered by managers and staff trying to cope with changing political fads and fashions in health policy.
‘Underlying every decision about the allocation of resources and the future of health and care are questions about values’
Political interference is often blamed for the short-termism of healthcare planning, for placing those who shout loudest ahead of those with the greatest needs, and for standing in the way of progress when that necessitates changes to existing services.
These concerns are well founded. But is the answer to take out the politics, or does the NHS need to get better at engaging with politicians and political imperatives? Is it even realistic to think that we could take politics out of the NHS, or that if we were to divorce healthcare decision making from the political sphere it would actually be beneficial to the nation’s health?
NHS embracing democracy
As intense media debate, and occasional panic, about the NHS continues to place a spotlight on health services, it is easy to blame journalists and politicians for standing in the way of rational, long term planning in healthcare. Could managers and clinicians not just be left to decide what is right for patients based on objective evidence of need and benefit?
Underlying every decision made about the allocation of resources and the future of health and care are more subjective questions about values, experiences and competing demands on finite resources.
‘Opening up NHS decision making to the public is much less of a threat than an opportunity when it is done well’
As imperfect as they may be, political arenas allow us to have those debates and make difficult but necessary choices about priorities. Nowhere can, nor should, the NHS be insulated from democratic accountability for the way it spends public money and supports the nation’s physical and mental health.
Many parts of the NHS now embrace some form of democracy. Foundation trusts, through their governors, have some degree of accountability to those who use their services. Clinical commissioning groups do not have any direct accountability to their communities but they do have to align their plans to their local health and wellbeing strategies and can be taken to task by local authority scrutiny committees. Nationally, despite the complex wiring of new NHS structures, the system must still account to Parliament for how it spends £110 billion.
Some NHS organisations, including many mental health commissioners and providers, go further still. From using citizens’ juries to debate local priorities, to putting service users in charge of commissioning services − opening up NHS decision making to the public is much less of a threat than an opportunity when it is done well.
Embracing the political sphere, rather than shying away from it, will achieve better results in the end, despite the discomfort of the journey.
‘Members of parliament play a crucial role in scrutinising government and the NHS − more often for good than for ill’
The Centre for Mental Health is among a group of national mental health charities launching the Local Authority Mental Health Challenge – supporting a network of “member champions” for mental health in councils across the country. You can follow the challenge’s progress and hear news from some of our champions on Twitter.
A positive impact
We believe that political leadership can make a positive impact − in building up public understanding of mental health, in supporting people who have mental health needs to be involved in decision making, and in fostering partnerships between services to improve the lives of people with mental health conditions.
Nationally, too, political leadership is vital for the health of the NHS. Some of the most effective health ministers from Bevan onwards have brought about lasting change for the better in health and healthcare by leading the way in challenging established practices and inequities. Members of parliament play a crucial role in scrutinising government and the NHS − more often for good than for ill.
Taking politics out of the NHS may seem desirable, but could in fact be the wrong direction entirely. Making politics work for the NHS, in contrast, might be crucial for its future success.
Sean Duggan is chief executive at the Centre for Mental Health