The Aims
- Re-establishing the NHS as the world leader in Healthcare; measured by the quality of care, equality of access and cost effectiveness.
- Encouraging the NHS to take a world leading role in medical science and technology.
- Nurturing the NHS with rigorous daily scrutiny and sound long term planning.
With these three ongoing fundamentals.
- Complete democratic control of the NHS remains and will be enhanced, wherever sensible to do so.
- Consistent highest quality service, delivered with maximum efficiency and minimum waste.
- The Government at Westminster loses all powers as to how money is spent within the NHS, but retains all powers to set the total NHS budget.
How long will it take?
2026/2027 – Raise support. The stronger the voice from individuals working in the NHS (current, past and future) the better.
2028 – Launch a national campaign for No Politics in the NHS. The aim is to ensure that the next Government, run by no matter which political party, is committed to carrying this through. Win the Argument!
2029 (General Election year?) – The new Government will continue to have direct responsible for the NHS but will now be committed to putting the necessary preparations in place to ensure it is the last government to have that direct responsibility.
2029 to 2035 – The “necessary preparations” may well take the full term of the Government. No problem. The process must not be rushed, the essential groundwork demands care and all appropriate practical trials must be carried out.
2035 – Assuming the Partnerships are in place at Locality level and the NHS Assembly is established at National level, the newly elected Government can organise the transfer of powers within its first year.
- Preparing the Ground at Locality Level.
Invite participation in “trials” to test out the idea of the Local Partnerships. These can be set up whilst the new NHS Assembly is being planned. The first step for an effective Local Partnership is to ensure that the new “scrutiny” role is up and running (Foundation Stone points 1 to 4). During the “trial” period, each “Local Partnership” will be responsible for proving that it is operating with maximum public support. As soon as all this is clearly in place, the established Local partnerships will each be allocated a minimum of £1m to promote community initiatives (Foundation Stone points 5 to 8). This £1m grant can be made renewable each year during the whole trial period. - Preparing the Ground at National Level.
With the commitment to “No Politics” in place, Government resources can now be exploited. Extensive consultation is needed not just with NHS professionals and the public but also getting input from leaders in business, technology, the universities, the legal profession and more.
The first stage is to challenge. Basically is anything worth keeping from all the politically inspired “restructuring” reforms of the last 40 years? Some of the questions. How damaging is the split between primary and secondary care? Do ICBs bring any “added value”? Is the “Trust” model viable? Why are service standards in hospitals variable at best and deteriorating at worst? How much is the NHS wasting by loose and inefficient control of its multiplicity of contractors and suppliers? How can the work of GPs be improved? Why do patients have to struggle to access NHS services? Why are there such inconsistencies of service at both local and regional level?
The second stage is to build. How can the NHS (respecting its founding principles) be returned to its most streamlined, efficient structure? The aim is to have a clear blueprint drawn up, with an outline of all the stages necessary to get there. Again this may well take time as we will be rectifying 40 years of mismanagement. A careful step by step approach is critical, but we can be sure that every step, no matter how small, will be seen as progress. - The National NHS Assembly.
This is the oversight body. Based on a significant input from the Local Partnerships, between 50 and 100 delegates should be sufficient. All delegates will be elected democratically and will take decisions democratically. (There is ample time to work out the best voting procedures later. Wide consultation is essential). Once elected, members are charged to carry through the three NHS AIMS as set out above. Obviously in the early years, members will also have direct responsibility to ensure that the new streamlined structure is put in place efficiently and effectively.
The Assembly will have all powers to run the Department of Health (currently in a merger process with NHS England). Assembly members will need to establish a leadership structure, for example whether appointing one senior person (equivalent to a “Minister of Health” ) or operating with a range of “leaders” representing the different NHS service areas. Members will also need to set up their own “Chair” to oversee their sessions.
Some possible new thinking …
The Assembly to be sited away from London. Assuming terms of around 4 years, then two terms should be sufficient for each delegate? Individual delegates can apply to stay longer but that will require approval from their own locality and from fellow delegates. Maximum encouragement for the widest range of people to stand for election as delegates. Also maximum support for individuals to be able take up their previous careers after making their contribution to the Assembly. The appropriate salary and pension level? Maybe no “standard” rate but flexibility depending on the delegate’s individual financial resources? The latest technology to be exploited to ensure maximum transparency and access for members of the public to make their voice heard.
Graham Cartmell