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Put Patients In Charge of Nhs Purse Strings

  • Patients should be allowed to take charge of NHS commissioning groups
  • Proposal would help tackle “crisis of accountability” in health service
  • Major role for unions and friendly societies in decentralising NHS

Patients should be given a direct say in how NHS money is spent through the creation of patient-led commissioning groups, a new Civitas paper argues.

The proposal, which is backed by the MP leading the Tories’ backbench public services policy review, is designed to address a “crisis of accountability” in the health service which contributed to the Mid-Staffordshire scandal.

The move would amount to a major decentralisation of power that would allow patients to shape the services they get from GPs and hospitals rather than leaving spending decisions to politicians, clinicians and NHS managers. It would also help keep healthcare costs down by decentralising pay bargaining.

The development could be achieved without upheaval, as the new Patient-led Commissioning Groups (PCGs) could be introduced incrementally alongside existing CCGs and NHS England.

Membership organisations such as unions, friendly societies, mutuals and cooperatives could act as “first-movers” in the creation of the PCGs, researcher Anton Howes suggests in the paper, ‘A National Health Service for Patients’.

“The NHS suffers a crisis of accountability. The gross negligence that has come to light at Mid Staffordshire is an extreme example of the current system’s failings, but the entire service is susceptible to similar abuses because of a lack of direct accountability to patients,” Howes writes.

“As the funders and beneficiaries of care, it is right that care should be directly accountable to patients, rather than only to politicians, managers and clinicians. This is the only way to ensure that the NHS becomes an organisation that puts patients first.

“The proposed PCG model provides opportunities for fully joined up care, with PCGs able to secure and commission primary, secondary and social care for their members.

“It also relieves a burden from clinicians who worry about being forced to make rationing decisions at the expense of the individual needs of their patients, and which could result in conflicts of interest and growing distrust for clinicians.”

The need for patients to be involved in commissioning is especially important given the growing pressures on the NHS budget and the consequent rationing that takes place at all levels of the NHS.

Howes details the ways in which rationing decisions are routinely made by NICE, political leaders or clinicians without the direct input of patients. NHS managers also make rationing decisions in, for example, the closure of wards and reductions in both beds and length of stay.

He proposes a system whereby individuals would be allowed to register directly with non-clinical, or patient-led, commissioning groups, which would be able to commission GP services, other primary care services and hospital services.

“This measure would allow patients and the public to form their own commissioning groups, or directly empower others to do this on their behalf, negotiating contracts with both primary and secondary providers,” he says.

“Rather than simply caring for a passive public caught within the catchment areas of a few GP practices, patient-led groups would cultivate an active membership, able to be directly involved in decisions and hold the group’s management’s decisions to account.”

These PCGs could be set up by existing member-based organisations like trade unions, non-profit mutuals like friendly societies and cooperatives, he says.

“Indeed, trade unions and friendly societies in particular would be able to rebuild the legacy they had of purchasing healthcare for their members long before either National Insurance or the NHS were introduced. However, they would be able to operate within the NHS rather than outside of it.”

There are many managers that have been left unemployed since the abolition of PCTs who could carry out the required functions – but they would be accountable to their members, the patients.

The proposal is backed by the Conservative MP Steve Baker, who is leading the Tory backbench review of public services ahead of the next election manifesto.

Steve Baker said: “As Chairman of the Conservative Public Services Committee, I am delighted Anton Howes has written this first-class paper on increasing public involvement in health commissioning.

“NHS England Medical Director Sir Bruce Keogh has referred to the value patients bring to improving health services. It’s now time to move past party politics to make that value real in the NHS. Anton has shown us how.”


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