More on the conference motion

In a post yesterday, I took issue with a few of the points in our conference motion, in particular 9) that talks about a “majority of councillors”.

Well, this had me wake up in the middle of the night and unable to sleep. I’ve now decided that Conference took the notion of “democratic accountability” way too far. Healthcare is as much an industry as is making paint. It is nonsense for a bunch of councillors to tell a commissioning consortium what to do as it is for a councillor to tell Dulux how to make paint. It also makes a mockery of two key goals of the legislation: to make healthcare physician-led, and to remove it from political micromanagement.

Adding a “substantial portion” of elected councillors (point 5), let alone a majority (as implied in 9) replaces national political interference with much more pervasive local interference.

However hidden in all this is the kernel of a good idea: having a councillor or two in a commissioning consortium is a good idea. It allows oversight, local representation, and a channel-of-last-resort for complaints. It also enables communications and easier integration of primary healthcare with the wider Public Health and Social Care services envisioned under the remit of local authorities.

It is also correct that the commissioning consortia need to be accountable, not just to patients but to the tax-payer who funds them and to professional bodies. However, these requirements don’t translate into a need for elected councillors. Instead, they require full transparency, patient consultation, complaints procedures, professional standards and fiduciary responsibility. And ultimately, sanctions for bad conduct.

There is also no good reason for the catchment area of a commissioning consortium to be co-terminous with a local authority. Given living and commuting patterns, in many cases I suspect that it is non-sensical. It certainly inhibits specialised commissioning consortia which may require large, regional catchment areas. It also feels deeply illiberal.

As a consequence of this midnight epiphany, I find I disagree with the thrust of points 4 to 9 inclusive. On accountability of the consortia, that is the section I’m reviewing next, so I may yet change my mind on some of this.

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