Yesterday 23rd Feb 2011 I had a glimpse of the future.
We are in a time of rapid change in the NHS. Few people yet understand the details and fewer can predict the outcomes.
As a result of the public perception of what happened at Stafford, and the way in which it resonated with the press and media, Andrew Lansley has justified his decision to cut two whole tiers of the management of the NHS. The Primary Care trust, and the Strategic health authority are both going.
It is interesting that the health bill was initially supposed to take on board the recommendations of the Stafford Public inquiry, but the time scales may make this impossible. The Inquiry in its slow and painstaking examination of the evidence of many individuals is painting a much more complex and balanced picture of what happened at Stafford, than we have so far seen through the press. It is by no means certain that the recommendations that the Inquiry will make will be what the secretary of State wishes to hear.
But without waiting to see what the Inquiry tells us about the state of the NHS and the management needs, the structures are changing now.
Yesterday I went along to take a look at the first meeting of the joint Health scrutiny committee, which brings together the Borough and County scrutiny committees. The Chief executive and Chair of Stafford hospital were there to give a presentation and to answer questions from the assembled councillors and from the public gallery.
This new committee is set to take on the role of overseeing the performance of the Hospital and the health service in this area. It will scrutinise the performance of the brand new GP consortiums who will take on the role of commissioning the health services in this area. None of us have any idea of how well this may work.
What I saw, looking down from the public gallery was the normal assortment of middle aged, middle class, councillors, all who are in some way concerned for the good of the community, but few if any who have the requisite skills or experience to know if the health service is being run well or not. The questions from the floor were interesting. Many seemed to be based on anecdotes - things that the councillors had learned from a friend. Few seemed to ask the deep questions that are necessary at this time.
I suspect that most of the individual councillors in the committee would if asked indicate that they are not sure that they are well qualified for this job.
The Chief exec recognises their difficulty. The Councillors had raised question about being able to carry out on the spot inspections of the hospital. He was quite amenable to this, but also suggested the need to provide some basic training for councillors to give them some indication of what they might be looking for. Going in and looking round is very unlikely to give the kind of in depth insight into the workings of the hospital that we as citizens will now need these councillors to have.
The make up of the public gallery was interesting too. The pressure group were there in force. There was one gentleman who had been associated with the health councils that were disbanded some years back, one ex councillor, and myself. That was it.
I think it is worth pointing out that on the basis of a perception that may be ill founded, massive changes are being made now to the structure of the NHS. The job of scrutinising the NHS has been shifted from paid professionals who understood the task to amateurs who have got there through election to the councils and who may or may not have the necessary skills. The only members of the public who are interested enough to be there are people with a specific interest, which may or may not be representative.
At the moment this body is simply taking a look at what the Hospital and other aspects of the health service is doing. In the future it will be rubber stamping passing the responsibility for delivering service into the private sector.