NHS reconfigurations, New Labour and local democracy.
| Author | Scorer, Richard |
| Position | Features - National Health Service |
'Localism' and 'empowerment' are two of the latest buzzwords of New Labour. Ruth Kelly's declared aim is to 'give local people and local communities more influence and power' (2006). According to James Purnell, 'New Labour is not just about modernisation, but also empowerment. New Labour's lodestar has been modernisation and that continues to be important. But it needs to be twinned to a moral goal, or it risks becoming technocratic. I believe that goal is empowerment ... Empowerment means embracing radical devolution ... Our approach to each policy should be to try to devolve power to the lowest possible level' (2006).
This sounds like a welcome and long overdue reversal of New Labour's centralist, all-controlling, top-down politics. Yet probe further and what exactly is the substance of New Labour's localism? Alan Milburn argues, 'If we are to deliver truly person-centred, customer-focused services then the next phase of reforms must involve putting power into the hands of the individual citizen' (2006). All well and good; but Milburn's comments also illuminate that, in New Labour thinking, the purpose of localism is not to extend democracy and devolve power as ends in themselves. Rather, localism is viewed in New Labour as one of a number of mechanisms to promote public service modernisation. For example foundation hospitals, although presented as enhancing local accountability and democracy, are essentially vehicles to introduce greater competition into the NHS. Thus, New Labour localism is not about extending democracy per se, but about ensuring that poor performance by service providers is punished and thereby avoided through mechanisms of local accountability. As Milburn proposes, if your local PCT board fails to deliver on that waiting time commitment, you can throw it out and elect another one.
However, the problem here is that what constitutes service improvement is usually defined by Whitehall; the flip side of New Labour's vision of localism is that, where local democratic wishes appear to impede or conflict with the Whitehall ambitions for service modernisation and marketisation, local wishes are likely be ignored. Purnell tries to acknowledge this problem: 'Empowerment is challenging for Westminster politicians and Whitehall civil servants. It means overcoming the natural tendency of all governments to think that they know best, and to talk about giving people power in theory while fearing doing so in each individual circumstance' (2006). In practice though, New Labour has frequently succumbed to precisely this tendency. In this paper I highlight an area which I believe illustrates some of the problems in New Labour's approach to localism, namely the public 'consultations' now taking place in communities across the country regarding 'reconfigurations' of hospital services in the NHS.
'Reconfiguration' is a hot button issue, as every Labour activist knows; it's been damaging to Labour support in many communities and it's one of the reasons why Cameron is edging ahead of Labour on the NHS. Labour's unpopularity on the NHS is caused by a number of factors. But I believe that an important, although often overlooked, factor is the undemocratic manner in which reconfiguration decisions are taken within local communities. These are sensitive and important decisions for local communities, and people want a voice in them. What they all too often get, as I explain below, is sham 'consultations' with manipulated, preordained outcomes. I believe that the lack of democracy in the process arouses as much hostility as the decisions themselves. It confirms people's worst perceptions of New Labour--that it is centralist and controlling. It turns people off politics. It may prove to be extremely damaging in electoral terms. But New Labour can also learn lessons from this fiasco, and do things differently--more democratically--in the future.
'Reconfiguration' is explained by the Department of Health as a 'strategic shift in the delivery of health care' with 'fewer patients treated in hospital and more services delivered closer to home' (DoH, 2006). Reconfiguration is generating...
To continue reading
Request your trialCOPYRIGHT GALE, Cengage Learning. All rights reserved.
