The Francis Report shows the tragic consequences when patients and carers do not have a voice and are not heard. Improving systems, management and inspection is part of the answer. But this does not address the lack of democratic accountability and scrutiny in health matters. A Parliament for Health could strengthen democratic scrutiny and accountability of all provision and legislation that affects health by creating a representative forum on health matters within our system of Parliament rather than Whitehall or the NHS. It would consist of representatives of stakeholders concerned with all aspects of health, including patient groups, staff, researchers, civil society organisations and elected representatives from other tiers of government, including parish and local councillors and MEPs. It could be co-chaired by back bench members of parliament. In time it could have directly elected ‘Health Representatives’ and be part of to a new kind of second chamber, to draw a wider range of experience and expertise into the political process. But MPs could set up a “Health Parliament”or Forum as an extension of the Select Committee to strengthen their oversight of health matters. A Parliament for Health could have statutory rights to discuss all legislation that impacts on their health, conduct investigations into the implementation of policy and report directly to the House of Commons through their Member of Parliament (the Co-Chairs). It would have the following tasks:
- Propose national priorities in health, for the NHS as well as public health;
- Hold the NHS Commissioning Board, Monitor and other strategic health bodies to account on behalf of Parliament (which should have the final say);
- Oversee and hear reports from our representatives on the World Health Organisation, EU Council of Health Ministers, the Food and Agricultural Organisation (FAO) and other international bodies influencing health policy;
- Promote dialogue round important issues, such as the Francis Report, the Bristol Royal Infirmary inquiry etc;
- Recommend priorities for research and development in health policy and provision;
Organise public consultation on proposals by the Government, taking consultation on major health matters from the NHS and Whitehall;
- Pre-legislative scrutiny of proposed bills before they are presented to the Commons, to draw attention to health implications
- Scrutinise and revise legislation through a “public reading stage” before the second reading in Parliament;
- Contribute to consensus building, where appropriate;
- Advise and assist on policy implementation;
- Monitor implementation of all policies that affect health;
- Review and evaluate the impact of legislation.
This is a big and important agenda. Failures in the NHS are symptoms that this has not been done by Parliament and the lack of proper democratic oversight and accountability. Simply putting “patients in control” through market mechanisms will not solve these strategic problems. If greater choice, commissioning and markets have a role, then the rules and political oversight are even more important. The House of Commons simply does not have the capacity to address these issues, even if MPs had the knowledge and experience to do so.
A Parliament for Health could develop a model for “Citizens’Policy Forums” to improve democratic government by strengthening public participation and connecting civil society with the political process in new ways, using interactive meetings, the internet and imaginative forms of active participation, round the issues people care about. They would be a form of practical political education, through which people learn how to contribute their experience and expertise about health to the policy-making process. Regular, statutory Citizens’ Policy Forums could replace ad hoc consultative bodies, strategic partnerships and advisory groups in Whitehall with a more open, accountable and interactive means of involving civil society in politics between elections. They would draw a much wider range of people into the Parliamentary process, contributing to the scrutiny of legislation and Government from the perspective of broad policy areas, rather than a party political perspective. Members of Policy Forums would be obvious candidates for an elected Senate. As a new kind of parliamentary chamber, Forums would also create new routes into Parliament and widen the pool of potential members of Government while strengthening the primacy of the Commons. Instead of being the last western country to have an elected second chamber, Britain could be the first to create a new kind of parliamentary process which enables citizens to take a more active part in politics between elections through the internet, participatory community meetings and the democratic associations of civil society. Civil society organisations should take the initiative and create a Health Policy Forums to scrutinise and challenge Government, because the cost of not taking into account the breadth of experience and interests in health is too high.