Who can say ‘No’ to a new hospital?
Government plans to spend on hospitals require extensive public involvement and consultation.
Rejoice! Hang out the bunting! Pop open the champagne! Celebrate! A bright, gleaming new hospital must surely be one of the most coveted assets a locality can acquire. Who can possibly complain?
That must be the thinking behind the Government announcement of a new ‘Health Infrastructure Plan’ (HIP) for England with a promise of £2.7bn of cash to rebuild hospitals in London, Harlow, Watford, Leicester and Leeds. That is Phase One or HIP1. Green light means Go. Start work, everyone.
The next phase will be called HIP2. This is an amber light. Twenty-one Trusts (strangely, 17 of them in the South of England!) will share £100m seed-funding, to develop plans for new hospital buildings and services for the 2025-2030 period.
In due course, there may be a HIP3, with an open competition to decide who gets the capital. And, so as not to forget, this is in addition to £853m extra promised by Boris Johnson in August, for 20 other projects. Green lights there too, so it seems.
It would be churlish for anyone who believes in the NHS to denigrate announcements like this – even if they have more than a whiff of electioneering about them, and even if the geographic distribution of the money will raise eyebrows. And, as health professionals point out, they merely make partial amends for the drastic freeze on capital spending since 2010. Apparently, the maintenance backlog stands at £6bn with half of this thought to be ‘safety-critical.’
By any standard, these are huge sums of money. So we all hope they will be well spent. But who decides? NHS England has a long-term plan that had very little to say about massive capital projects. Its major thrust was on reducing the role of hospitals and moving strongly towards community-based services. It placed a huge emphasis on primary care and explicitly relied upon politicians finally deciding what to do about social care to meet the needs of our ageing population. Implementing this policy continues to demand service reconfigurations that centralise many functions and close hospital beds all over the country. Do the latest announcements amount to a reversal of this policy?
The irony is that when the NHS engages constructively with local people and patients – as it MUST, by legislation, it often finds that their priority may not be to build that gleaming new hospital, no matter how much politicians may wish to perform the opening ceremony. According to the King’s Fund in this week’s timely update to their excellent article on The Politics of Health, public attitudes towards the NHS have changed for the worse. In 2018, public satisfaction with the way the NHS runs nowadays was at its lowest level for more than a decade, and this was mostly because of anxieties about long waits for appointments, staff shortages and a lack of funding.
People seem to have worked out that bright new facilities without the staff to work in them is a misplaced investment. What they want is for the NHS to recruit for its current 100,000 vacant posts. And it wants better access. Satisfaction with the process of making a GP appointment has fallen by 12 percentage points in the last seven years. Even if more doctors are recruited, too many GP Surgeries lack the space to accommodate them.
Not everywhere, of course. Every area is different. Pressures vary, and patient pathways have local variations. Even if he got the structures wrong, Andrew Lansley was right in thinking that local clinicians might know better than Whitehall bureaucrats where health improvements might most readily be made in any particular area. But alongside them, we must hear the voices of local people.
It is a tribute to many NHS Managers and also to Social Care Directors in Councils that we are beginning to see really effective public engagement and consultation. It often takes place in a painful context with services being removed from long-established centres and further away from communities with limited transport facilities. Best practice consultation requires a close dialogue with representative bodies – both permanent ones like Healthwatch and Overview/Scrutiny Committees – as well as ad hoc groupings of concerned patients and can focus on mitigating actions where the case for change proves the best way forward.
Funding announcements require the same level of engagement. So frequently have we had to seek public and patient participation over bad or unpopular news that it sometimes feels as if we have forgotten to consult on good news! Yet it is vital. Without public input, it is quite possible that we may invest in the wrong things. Is the gigantic hospital really what is most needed? Or is it better care in the community? Or better Urgent Care Centres? Or GP surgeries?
Potential recipients of the Health Minister’s funds probably fall into two categories:
- Those with firm, detailed plans for new facilities and services, maybe long-developed and long-awaited
- Those who are yet to formulate their plans but have serious or urgent health improvement needs that must be addressed.
In both cases, there now needs to be an urgent dialogue with local communities. For those who are well prepared, there should be consultation on their plans to ensure full public support and to identify issues and concerns about the health/social care system as a whole. It is the chance to get it right, and we know that top-down plans are not always ideal. For those in the second group, they need to start with pre-consultation engagement to establish local people’s priorities and preferences. They should move as soon as possible to the Institute-recommended Issues paper stage and avoid at all costs jumping to preferred options before listening to their staff, their patients and local opinion-leaders. And they must commit to a full sequence of consultation, as NHS England prescribes, and the law requires.
In many ways, these are exciting times for towns and cities offered the prospect of long-delayed health infrastructure. Of course, it may not all happen. But if it is a truly National Health Service, it should be the people as a whole that guide its development – not just the clinician, the bureaucrat – or even the politician.