Tuesday, 15 March 2016

The erosion of accountability in the NHS

"The #JusticeforLB movement has succeeded in exposing the most disturbing and penurious facts about the British states treatment of learning disabled people since the Winterbourne Inquiry (which detailed the criminal abuse by staff of patients at a privately owned care facility called Winterbourne View Hospital, near Bristol, but was only exposed by the work of undercover journalism supported by the BBC’s Panorama team). "

"Since Connor’s death, many have come forward to speak about ongoing failures in care for learning disabled people, about neglect, about their struggles to get answers about the deaths of loved ones, and about their fears for the future in the face of seemingly permanent reductions in funding for adult social care. In the context of permanent austerity, Connor’s death raises fundamental questions about the future of welfare itself. "

"Indeed, it is imperative that we understand #JusticeforLB’s struggle for accountability within the context of what Youssef El-Gingihy calls the `virtually impenetrable` Health & Social Care Act 2012, which came into law three months before Connor’s death. One of the first casualties of the Health and Social Care Act was accountability itself - as Jacky Davies, John Lister and David Wrigley note in their important account of the systematic demolition of the NHS, NHS for Sale: Myths, Lies and Deception. Questions about the impact of NHS reforms on accountability were raised by many before the Act came into law; see for example Accountability in the NHS: Implications of the government’s health reform programme and Lords warn on ministerial accountability in NHS reforms."

"While we know why Connor died (he died of neglect), to have his death accounted for has proven more challenging. This is due in no small part to the baffling complexity of what we used to call ‘the National Health Service’ (NHS). In effect, the NHS no longer exists, or at least not in a form those who created it would recognize..."

"Today, the closest thing we have to central governance, and national level accountability, within the NHS is `a body` called NHS England, which receives the bulk of tax-payers funding to pay for the services we receive. NHS England is primarily a commissioning body, however, the bulk of actual commissioning work is devolved to local ‘Clinical Commissioning Groups’ (made up of a select few doctors and nurses, ‘health managers’ and a significant number of private health company representatives and shareholders) who commission services from a range of public and private ‘service providers’."

"These changes in the government of the National Health Service were made, the public was told, in order to `liberate` hospitals, GPs and local authorities. As of 2012, this tangle of ‘NHS bodies’ would decide what kinds and levels of provision to make to the public."

"Much of the groundwork had been laid by pro-market ministers under Tony Blair’s government, who started encouraging NHS hospitals to become business-like ‘Foundation Trusts’ but Cameron’s 2012 Act seriously ramped up the shift from central, state accountability, to ‘market’ accountability, leaving local NHS managers no other choices."

"In the case of Connor Sparrowhawk, the ‘liberated services’ which had been ‘commissioned’ to care for him were provided by an NHS Foundation Trust called Southern Health, who are one of England’s largest providers of ‘community health, specialist mental health and learning disability services’. Mazars concluded that those in charge of overseeing the delivery of Southern Health services had catastrophically failed. In particular they noted that a ‘failure to bring about sustained improvement in the identification of unexpected death and in the quality and timeliness of reports into those deaths is `a failure of leadership and of governance`."

"What are the consequences of this failure? Who can be held to account in a context where the government has devolved its `constitutional responsibility` to provide NHS services? Where does legal and political responsibility lie? With those whose neglect contributed to Connor’s death? With Southern Health? With the CCG who commissioned their services? With NHS England? With the Secretary of State for Health? If all of these ‘bodies’ are in some part accountable, who can hold them to account, what are the systems for accounting?"

The hollow rituals of apology without accountability
"On December 10th 2015, the leaked Mazars findings provoked the tabling of an ‘urgent question’ to the Health Sectary Jeremy Hunt in the House of Commons. Hunt made a public apology to Sara Ryan and her family. Hunt thanked the #JusticeforLB campaign, and suggested he was grateful for their exposure of the failures at Southern Health."

"However, in his co-authored 2005 book, DIRECT DEMOCRACY: An Agenda for a New Model Party, Hunt not only put forward a case for the privatisation of the NHS, but specifically argued for an end to government accountability for the welfare state. The introduction stated, `what is needed is not the accountability of services to central government precisely the error of the Attlee settlement whose failed systems we still inhabit.`"

"Attlee was the Labour Prime-Minister (1945 to 1951) who oversaw the development of the post-war welfare state. His Health Minister, Aneurin Bevan, created the National Health Service (NHS) in 1948. Hunt’s political ambition, to rid the government, and specially the Department of Health, for accountability for failures in care, is precisely what has come to pass, through the establishment of NHS England, and chaotic and ill-prepared local Clinical Commissioning Groups. Decentralised ‘accountability’, said Hunt's book, ‘must be direct, democratic and local’. In actuality Hunt’s ‘devolved’ accountability equates to market-based accountability, which exercises authority through obfuscation - strategies which seems to centre on tiring out those who attempt to question and challenge."

"To put it more plainly, permanent reductions in public services necessitates the erosion of structures of accountability. "

The bones of hope
"The #JusticeforLB campaign has exposed the extent to which NHS ‘reforms’ have undermined systems of public accountability for publically funded services. This has been no small undertaking, but has involved the harnessing of an arsenal of digital and off-line activist strategies: twitter, blogging, vimeo, the #LBBill, the Justice Quilt, the Justice Shed, films, art exhibitions, picnics and flags. This is a movement grounded in grief and love, but moved, agitated, kept alive, by the promise of justice for people with learning disabilities, and the possibility of a different welfare future."

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