The Co-operative Party

The NHS is Labour’s greatest achievement. But it is not great because of its long-standing management structures or governance arrangements – rather because it delivers health care free at the point of need, irrespective of the ability to pay.

The reform of health institutions offers the prospect of maintaining this core value, whilst bringing health services closer to their stakeholders. NHS Foundation Trusts, Community Foundation Trusts and Social Enterprises in primary care all hold out the prospect of greater accountability to the public and staff.We commend the work done so far to promote community-based mutuality within the NHS, including the creation of 122 foundation trusts in England, with well over a million members. Foundation trusts are mutually owned bodies, regulated at arm’s length from the Department of Health and accountable to a widely defined membership. This has enabled a new model of healthcare that is controlled and run locally; giving staff, local communities and other stakeholders a far greater voice in how hospitals are run.

Through the greater involvement of staff, users and local communities, it has been demonstrated that we can not only strengthen citizenship, but also build services based on the frontline expertise of staff as well as the needs to the people that they serve. Evidence from an independent report commissioned by the Department of Health has shown that the unprecedented level of patient and public involvement in healthcare is making a real difference. Moving to the mutual model has changed the way that these hospitals are run, making them more responsive to local people and more focused on patients’ needs. Yet the transition to mutuality is part of a process and foundation trusts are still in an early stage of their development. The Government should make certain that Monitor fulfils its role as regulator fully, ensuring that approaches taken to membership and governance comply fully with their mutual status.

We therefore call on the Government to continue to press towards its objective of ensuring that all English hospitals attain foundation status, avoiding a two-tier system. Yet it is not only in secondary care that mutuality has a lot to offer. Co-operative ideas already have a strong base in primary care. Many GPs are involved in out of hours co-operatives and other GP practices. As GP led health centres are developed, the Co-operative Party believes that mutual models, along similar lines to the out of hours model, can put health care professionals at the heart of an improved service proposition.

As more responsibilities are devolved to service users and the public, we also need to explore ways of improving the legitimacy and accountability of primary care trusts (PCTs) and of the commissioning decisions that they make on behalf of their local communities. We welcome the fact that the NHS Constitution ensures the right of patients and the public to be involved in the planning of healthcare services. It is important that structures are developed which give people a real say over which health services are commissioned. The Government should ensure this through an independent review of PCT governance and accountability, which should be informed by the experience of mutual and social enterprise providers within the NHS and innovation already occurring in PCTs across the country.

In England, the split in primary care between commissioners and providers offers a further opportunity to create a new wave of staff-led, patient-centred social enterprises. These have the potential to free NHS staff to innovate and meet the needs of their local populations, while at the same time ensuring more direct accountability for service users.

The Co-operative Party welcomes the fact that all English NHS staff have been given the ‘right to request’ moving the services that they provide into social enterprise organisations. The Government should ensure that PCTs have a commissioning strategy that ensures a future role for mutual and social enterprise and that they are prepared to encourage the development of ‘right to request proposals. Funding should be provided for the development of business cases and business plans, to ensure a level playing field with other potential providers.

We also believe that it is important that clarity is introduced to ensure that the ‘right to request’ option is limited to those organisations that are legally committed to trading for a public or community purpose. While exact structures are likely to vary depending upon the nature of the differing services provided; it is vital that staff, patients, carers and the general public own and control the new organisations.

This goes to the very heart of what we believe in. Reformed health institutions can be a reflection of our co-operative beliefs. But this is not a by-product of a new constitution; citizen engagement requires new skills and ways of working. This is why the Co-operative Party is working closely with health professionals to design locally owned, mutual bodies that can meet people’s needs.