Only the people can find a way forward for the NHS - RSA

Only the people can find a way forward for the NHS

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  • Deliberative democracy
  • Health & wellbeing
  • Public services

In most election campaigns there are moments when an issue moves centre stage and shifts the balance. Today’s story about NHS targets may be one of those moments.

It is difficult to know what is worse; that A and E long waits are higher than at any time since the Blair Government set the four-hour target in 2004, or that the already very modest cancer diagnosis to treatment target of two months is now also being routinely missed. Add to these headline-grabbing statistics the experience most of us have had of ever lengthening waits to see the GP (this week my local GP said it would take 16 days to provide an appointment to my daughter even though children are a priority!). There is also the fact that, despite innumerable initiatives and additional funding, the number of old people trapped in hospital due to a lack for adequate social care provision in the community is rising again.

As much as this is all true it is also the case that every day the NHS provides incredible, dedicated care. A close friend of mine being treated for cancer describes with huge gratitude the professional and compassionate care she has received. She also worries about the wellbeing of her nurses working twelve hour shifts with virtually no breaks.

At a recent RSA seminar about social care a thoughtful expert said;

‘the UK could spend the whole of its GDP on health and still it wouldn’t be enough’

While this is an exaggeration and certainly more funding will always help, there can be no question that the long-term sustainability of the NHS’s core offer is in grave doubt.  Yet, so far, the election campaign seems to be merely a bidding war of funding promises plus some largely exaggerated allegations of privatisation. Also, as I wrote yesterday the Parties seem to have decided to avoid the sensitive issue of social care funding. For understandable and disappointing reasons, no major Party appears willing to recognise that we desperately need a broader debate about our health and social care systems.

So here is a proposal for whoever wins the election: A Citizens Commission on health and social care.

The structure of the Commission would combine deliberative and expert processes. An initial Citizens’ Assembly would give a representative group of people an opportunity to stand back from the present system and develop and weigh up various scenarios for future sustainability. For those who still aren’t sure about deliberation, this would be quite similar to a very successful initiative undertaken for three Select Committees last year. This Assembly would be observed by a Commission of experts appointed through cross-party agreement (which should include some people from outside the UK). Informed by the broad vision developed by citizens, the expert Commission would then start to develop detailed proposals.

The next stage would see the Expert Commission identify a set of options or choices. These would then be subject to a much broader process of deliberative polling, engaging several thousands of citizens through a robust on-line process of the kind being developed and trialled in various parts of the world. Following the Commission’s consideration of the outcome of this process there might be a final stage through which the initial Assembly would be reconvened and asked to endorse the final recommendations before they are formally sent to ministers. The whole process would be entirely transparent and would offer resources for local and special interest communities to undertake their own deliberative processes.

To make the NHS sustainable and effective and to safeguard its founding principles we need to ask big questions, to develop innovative solutions and make difficult choices. It is also vital that the public – who experience the NHS in practice and care deeply about it – are fully engaged.  During the election every Party will claim of every other Party that they can’t be trusted with the NHS. For different reasons, they may all be right. A combination of independent expertise and public deliberation is surely the way forward. 



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  • An interesting proposal. Lots of other options for the approach of course, including having a Citizens Assembly at the end of the process (with binding recommendations?) rather than at the beginning, and wider participation as well as deliberation in an initial exploratory phase rather than restricting participation to a small group (even if they have some 'representative' properties, they would still be a small group). 

    Also, I know that some at The RSA think this is a crazy idea even though most RSA Fellows I speak with think it is the essence of the RSA Fellowship, The RSA could engage its Fellowship in an initial exploratory phase of deliberation and participation around the future of health & social care, before structuring the convergence phase via techniques or approaches like an Expert Commission or Citizens Assembly. 

    What a great way to demonstrate The RSA's commitment to the philosophy of deliberative & participative democracy - to involve its Fellows and learn from their collective wisdom and ability to draw in others' perspectives around the UK, as well as involving the wider citizenry.