MP Blogs

The Health Bill is a missed opportunity to make important changes to the NHS which would empower patients, give real power and accountability to local communities and clinicians to shape health services in their area, and secure more efficient use of resources.

First, let's consider the case for a constitution. The NHS is a remarkable – and vast - institution. There are nearly 50 countries with populations smaller than the number of people who work for the NHS, and its sheer size and complexity is one of the reasons why an NHS constitution strikes me as an intrinsically good idea – provided that the document is worth the paper that it is written on.

But to be effective, and to help safeguard the NHS in the future, it has to be enduring and it has to offer something of substance beyond mere platitudes. I do recognise that a balance has to be struck because, on other hand, we do not want to tie everyone up in legal knots with constant battles in the courts over what the constitution means.

However, there is literally nothing new in this bill; no new patient rights or guarantees, no freedom to innovate, and no increase in accountability. While the 'pledges' in Labour's NHS constitution are inoffensive will it, ultimately, make any real difference to the patient's experience of the NHS?

A constitution which introduces real guarantees for patients on waiting times and access, and help makes the NHS more accountable to patients and staff, could serve the NHS well for years to come. Sadly, it looks like these proposals are unlikely to do this.

The Liberal Democrat vision for the NHS aims to preserve all that is best in the NHS whilst tackling the failures which have emerged because of micro-management from Whitehall.

Since I became the health spokesperson for the Liberal Democrats, I have set out a range of proposals which would ensure that patients know what the NHS can do for them and enable people to play a central role in deciding how the NHS spends their money.

We need to make the NHS more accountable. The Secretary of State for Health is currently the only person responsible for an organisation which has over a million employees and serves a million people every 36 hours. This is a crazy situation which, unbelievably, the Conservatives are proposing to make worse. Their proposals for an unelected, unaccountable NHS board are baffling.

Much of the rhetoric these days is about decentralising power but this is meaningless without genuine local accountability and responsibility. Local commissioners of health and social care should be democratically accountable and should have the power to raise an element of their funding through fair local taxation – with a commensurate reduction in national taxation.

Local health boards have worked in Scandinavia and can work here too. If the board was not able to deliver high quality care and make efficient use of resources, then they would be voted out of office. It really doesn't get more accountable than that.

Locally elected health boards would have the freedom to innovate, to find better ways of delivering healthcare, focusing far more on prevention, integrating health and social care, supporting those with long-term chronic conditions so as to avoid expensive and disruptive crisis admissions to hospital. By giving communities the ability to invest in health promotion and screening programmes we can bring local solutions to the pressing health problems many of our communities are facing.

So in this way, we rebalance the relationship between the state and local communities. But we must also shift power to both patients and clinicians. We would introduce an entitlement to treatment within a defined period of time for both physical and mental health conditions – failing which treatment would be paid for privately. But we should also develop the concept of 'self-directed care' where the patient can decide, with advice and support, how the available money is spent. This approach has been pioneered in social care and has often transformed the service user's experience. It should now be developed within the NHS, particularly in areas such as mental health, supporting those with chronic conditions and those with learning disabilities.

We must look at how we can re-energise those working in the NHS. It is remarkable that, after so much investment in health services, clinicians feel so disenfranchised and frustrated. At every level of the NHS, our mission should be to engage staff – both clinical and support staff - so that once again they feel that they have a say about the way their service is run and how it develops, rather than having change imposed from on high.

Developing the NHS in this way could achieve both better care and a more efficient use of resources.