The proper role of public officials

If there is a debate over the future of health services in Shropshire then it appears to have got off to a poor start, with polemic replacing reasoned argument.

As far as I can see, no decisions have been made, but options exist and appear to have been prejudged by local politicians before any consultation has taken place, damaging the prospects of any meaningful discussion.

As for the options, these it is now clear have been drawn up in liaison with local council representatives, the process agreed in advance, found satisfactory until an external appraisal says that finances would suggest the cheapest option is to downgrade services at Telford, at which point before recommendations are made, before consultation starts, the press is used to tarnish the process.

Who gains from working this way, no one other than those who oppose democracy, those looking to save their seats in politics. If we object now, then if the ‘wrong’ decision is made which we don’t like we can say we against it all along, if the ‘right’ decision is made, then we can say it was us than swung it, we can take the credit.

Looking at the options for 2020, or 2012-13, it appears change is inevitable. Why? Is it driven by a desire to worsen healthcare? a desire to save money? Obviously not, as every option costs more.

It is driven by a desire to improve care and to improve health outcomes. It is driven by safety of services. Who specifies these quality and safety standards, managers or clinicians?. The Royal Colleges dictate what is a safe service, what is acceptable to recognise a service as acceptable for training recognition, what levels of activity Doctors should see in order to maintain their clinical expertise, what number of Consultants are required to operate a safe and effective on call arrangement. They make their recommendations and then mandate health managers to take action.

If politicians want to say what is acceptable, then they need to understand the background to decisions and take responsibility for the decisions they make.

Does Telford and Wrekin want excellent health services, does it want the right Doctor to be able to give the right care at the right time? We can all wave shrouds, give examples of what bad might happen, gave examples of excellent care. What about those patients who didn’t get the right care, those who’s outcomes were worse than they ought to have been. What about the future patients who receive inadequate care because politicians were too busy thinking about their seat in office.

As for 2020, 2012-13. It appears there are three sets of issues, those immediate issues need to be addressed to provide safe services now, for services identified at potentially unsafe; what services would benefit from a greater critical mass enabling them to improve quality and outcomes in the medium term, following the latest recommendations of the Royal Colleges; and how should health services be organised in the longer-term, without predetermining this by any of the other decisions made on 2012-13.

Everyone wants all these services to be as local as possible, the danger to me appears to be that everyone wants to use decisions on 2012-13, to pre-determine the options for 2020.

I would suggest to local health managers, politicians and the like, that decisions on 2020 should be made first, or even at the same time as 2012-13. If this means decisions take longer, that the public get a greater chance to influence decisions and options, this is a small price to pay. I would also suggest that headlines in the press is no way to plan services and to consult properly, we need fewer headlines and greater public engagement and information.

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