When we come to look back at the history of the NHS over the current decade, with closure of local services causing anguish across the country, we may see this as the time when we were bound overly tightly to the idea that the clinician always knows best.
Indeed, this government’s blind faith in the clinical stamp for taking vital health services away could come to be seen as an early 21st century equivalent of the ‘Whitehall knows best’ mentality that gripped reforming governments after the second world war.
It is a mantra with the best of intentions, but time and again it is failing to take account of the views of patients who rely on the services that are being carved up by those at the centre.
Certainly, as services across the country are threatened it is increasingly clear that there is a yawning gap between the government’s rhetoric of listening to local people about their health service, and the reality that is seeing the clear wishes of residents ignored up and down the country.
Contrary to the fears of many experts, I believe patients do instinctively understand that every hospital cannot specialise in everything and it sometimes makes sense to travel to get the best treatment. Yet they demand their local hospital should have its fair share of the very best, and they believe strongly that accessible services is a basic part of quality health provision, not something to be dismissed as an unnecessary luxury.
Labour in 2015 should commit to a step-change in approach to give communities genuine power over the health services that residents pay for through their taxes.
Instead of ignoring local people, we need a system that responds when communities turn around and say: ‘We have listened to what you think is best, but we pay for this service through our taxes and we want things to be different.’
The time may have come for a People’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto which should be heeded; that principle should be enshrined in law.
Of course, it is essential that health professionals make their case when decisions are made. Their expertise is immense and people should not deviate from their plans lightly. However, it is by no means certain that any one group will always call it right first time, their views must be subject to real scrutiny and challenge.
Too often the clinical push for concentrating medical specialisms on a single site takes less account of local geography, travelling times and community links to health facilities, the things that matter to those who ultimately pay the clinicians’ wages.
This is not to make an argument for sentimentality in NHS resource decisions, and it is obvious that the views of local people will sometimes be irreconcilably different across a particular area. Yet when, for example, families in Barrow who may have very little disposable income could suddenly face a hundred mile round trip to visit a relative because a unit at our local hospital has been moved to Lancaster, their voices must be heard.
Labour should be proud of an approach that has helped deliver improvements in health outcomes across the country. But the current tension between national planning and local unrest is unsustainable in the long term. Instead, we need to recognise that progress in national health outcomes has sometimes come at the cost of alienating many local areas who understood the trade-offs but fervently desired to keep services close to them.
The Tory-led government has made that tension worse by their broken pledge to end local hospital service closures.
So it will fall to Labour to provide the change of direction we need. Local communities pay for the health services they receive; they deserve to be treated with greater respect.
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John Woodcock is MP for Barrow and Furness and a a vice-chair of Progress. He tweets @JWoodcockMP
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If you want a health service that functions properly then servies have to be rationalised to a degree. One of the reasons the NHS is so innefficient is precisely because of the success of local politicians in keeping unecessary and duplicated services open against the advice of clinicians. With an infinite budget of course the views of local people should be catered to but we do not have an infinite budget. Just take a look at the Whittington in London where excellent maternity and elderly services are at threat, in part because of a successful local campaign to keep an outdated and underperforming A&E unit open. This is particularly ridiculous in an area with as good tansport links as Camden/Islington. Well done local polticians.
That said, there is clearly a case for giving people what they want – as you say they pay for the service. Perhaps the answer is to completely change the way we provide services – ideally outside hospitals. Any service that could be provided outside hospital should be. Why not expand primary care and have local polyclinics providing walk-in emergency care along with most outpatient clinics. Have specialist GPs to reduce the need to go to hospital for diagnosis. If most people with respiratory problems see a GP who specialises in that area then fewer mistakes will be made and more of the unusual cases will be picked up. If you deal with more at a local level, outside hospital, then you can hopefully satisfy the public wish for easy access to services and still improve effectiveness and efficicency by centralising specialist units.