The Liberal Democrats in their election manifesto wanted local authorities to do the purchasing of NHS care. Even now, during Cameron, Clegg and Lansley’s “pause” in their NHS reforms, their activists are pushing hard for councillors to be given a much bigger role in commissioning.
This is a really bad idea. And Enfield council, in the first test of what the Liberal Democrats would like to be the new regime, have just demonstrated why.
The reason council commissioning of care is a not a good idea is that it mixes representation without taxation. Councillors have democratic legitimacy. But they don’t raise the money for the NHS.
So over the long term, giving them responsibility for commissioning is simply a recipe for councils to say there is not enough money in the system and to blame central government for the NHS’s deficiencies, rather than take hard decisions – hard in the sense that they are always locally unpopular – over how services need to be reshaped as medicine changes.
That was what almost invariably happened when councillors sat on health authorities back in the seventies and eighties. Today, Enfield has just made the point again.
Chase Farm Hospital in the borough has both accident and emergency, and maternity and paediatric services, that hospital clinicians locally believe are no longer safe. Indeed, it is 17 years since the closure of Chase Farm’s “blue light” A&E was first proposed and 15 years since the same case was made – again on clinical grounds – over the maternity care.
Enfield is bitterly opposed to the plans to transfer both these services to the nearby North Middlesex Hospital – a proposal that would leave Chase Farm doing more non-emergency surgery than at present, and still with an urgent care centre.
Despite endless rounds of consultation which have shown clear majority support among hospital clinicians and GPs across Barnet, Enfield and Haringey – all three boroughs and parts of Hertfordshire are affected by this change – Andrew Lansley, the health secretary, recently gave the council a chance to come up with an alternative strategy.
Today it has done so. Boiled down, its conclusion is “give us more money and keep everything open”. Point made.