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Tackling the crisis of accountability in the NHS: give patients a role in commissioning

Elliot Bidgood, 27 September 2013

The need for democratisation and accountability has long been a topic of debate in the NHS, and such discussion has only grown since the introduction of Clinical Commissioning Groups (CCGs) earlier this year, in which GPs are expected to indirectly represent the interests of their patients in the commissioning process. In light of this, Anton Howes has written a new Policy Ideas paper for Civitas entitled ‘A National Health Service for Patients’, in which he proposes the creation of new Patient-led Commissioning Groups (PCGs) – these would be mutuals set up by non-profit membership organisations such as trade unions, friendly societies or cooperatives which would allow patients to take direct control of commissioning.

This proposal would help tackle the “crisis of accountability” that currently exists in the health service and would amount to a major decentralisation of power. Rationing has been a historical challenge for the NHS and is particularly acute at the moment given current fiscal constraints, yet patients have little insight or influence when it comes to the sensitive priorities and values that inevitably dictate rationing decisions.

The proposal to some extent continues on from previous Civitas work on how to increase NHS accountability, notably a recommendation in 2003 to mutualise the Primary Care Trusts that preceded the current CCGs. It is also backed by Conservative MP Steve Baker, who is leading the Conservative backbench review of public services for their next general election manifesto. 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.”

The paper is accessible here. For more of our work on health, including books and research papers, visit our website here.


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