View from the street: We need transparency about emerging NHS changes

David Winskill wants more clarity about any changes to NHS in London.

David Winskill wants more clarity about any changes to NHS in London. - Credit: Archant

Marvin Gaye once asked: “What’s going on?”

As we learn to live with Covid, many people are asking how we are going to access GPs, visit A&E and where we go for operations.

Back in 2008 Lord Darzi proposed big changes to health delivery in London which received coverage on radio, television as well as in local and national newspapers: whether you loved or loathed his ideas, there was at least a lively debate.

This is in stark contrast to what is happening now under the cover of the Covid emergency.

In April, Sir David Sloman (NHS London director) wrote to the CEOs of London’s health systems.

He acknowledged the speed and agility of the NHS response to Covid. Yes, many services had been radically reconfigured and some suspended, but some new ways of doing things had improved patient experience.

He wrote “as we move into the next phase of the pandemic, it is clear that to be the healthiest global city, we will need to fundamentally change the way we deliver health and care going beyond the changes that we planned in the London Vision.”

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In a few short weeks, NHS in London had turned the toy box upside down and we now have an opportunity to think about how we put things back: what to keep or discard and what opportunities there are to change.

Hints are emerging about what London health delivery could look like: Area-based waiting lists – patients waiting for (say) a hip replacement would be offered a slot in any one of their local acutes rather than waiting to get to the top of (say) the Whittington list.

With reduced capacity in A&Es, there is a proposal to make attendance accessible only via 111 and a timed appointment. Some Londoners will warmly welcome these changes. For those with poorer digital services or English as an additional language, equality of access to services could be an issue. Change is being developed and managed by a senior group of administrators and clinicians supported by a cohort of expensive management consultants. The influence they are wielding is causing concern and, other than the occasional focus group, there is no systematic Patient Voice input. There is a deafening silence about these changes: MPs and councillors as well as Patient Voice representatives from all over London have only the sketchiest idea what is happening.

As we move from the acute phase of Covid, we must demand transparency, clarity and proper engagement before important decisions are taken without informed consent of Londoners.

The current command and control management style must now give way to a collegiate approach involving all stakeholders acting as critical friends.

After all, it’s our NHS.