You’ve been asked to have your say on the NHS. You just don’t know about it

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You’ve been asked to have your say on the NHS. You just don’t know about it

Ann Robinson

theguardian.com/commentisfr...

Jeremy Hunt has been uncharacteristically quiet about the public consultation on the health service. There are four days left to respond – let’s do it

The government is apparently very keen to hear our views on the proposed NHS mandate. But you’d better be quick; you have until 23 November to comment. And if you’re wondering how you missed such an important opportunity to comment on the future of the NHS, you’re not alone. Critics say the Department of Health has deliberately kept it quiet, with little publicity and only a month for the public to comment since the launch in October.

The mandate’s important. In its own words: “The mandate to NHS England sets the government’s objectives for NHS England, as well as its budget.” It “sets direction for the NHS, and helps ensure the NHS is accountable to parliament and the public”. A fresh mandate has to be published every year “to ensure that NHS England’s objectives remain up to date”. A new mandate is due to be published following the completion of the spending review, to take effect from April 2016. There’s a consultation document that sets out how the government proposes to set the mandate to NHS England for this parliament. And it’s this document that we’re invited to respond to.

But Caroline Molloy, editor of campaigning publication OurNHS says the process doesn’t suggest the government is keen to hear our views. “There has been no fanfare, no public or press statements and only very lackadaisical engagement with patient groups. It’s a sham.”

Molloy says we need to be aware of the mandate and its contents. “Since the 2012 changes, government is less accountable for NHS provision at a local level. Local clinical commissioning groups (CCGs) like Devon can attempt to stop providing routine operations for people who are obese or smoke, CCGs across the country are refusing people hearing aids for both ears and stripping away a host of other NHS treatment – and the government has effectively given away its power to stop them. The mandate represents the remaining political accountability by the government for NHS provision.”

Molloy thinks the government is planning to scale back what the NHS does and doesn’t provide. “Coded policy signals suggest to me that we are being softened up for the idea that the NHS is in crisis and we can’t afford to treat people as we used to.”

The fact is, an invitation to participate is meaningless if you don’t know you’ve been invited

In 2011 David Cameron promised “We will not endanger universal coverage – we will make sure it remains a National Health Service. We will not break up or hinder efficient and integrated care – we will improve it. We will not lose control of waiting times – we will ensure they are kept low. We will not cut spending on the NHS – we will increase it. And if you’re worried that we are going to sell-off the NHS and create some American-style private system – we will not. We will ensure competition benefits patients. These are my five guarantees.”

But Molloy is sceptical. She feels: “The message is shifting away from the NHS as we recognise it – a comprehensive, universal, publicly-funded service which is run ethically and is evidence based.”

Jeremy Hunt has been uncharacteristically quiet about the invitation to all of us to comment on the proposed mandate. He made a written statement on the launch day but as far as I could tell, doesn’t seem to have said anything much about it since. I asked the Department of Health how many responses they’d had but they responded that they couldn’t possibly say. I asked NHS England what they think about the mandate and they said: “The mandate is a matter for the Department of Health and the public (via the consultation on it) – we wouldn’t have anything to say on it.” So far, so Kafka.

Healthwatch England is a government-funded body with significant statutory powers, set up to champion consumers (that’s us) in the commission, delivery and regulation of health and social care. They get to see the mandate before the rest of us and comment on it. Last year, they liked much of what they saw, especially the moves to treat mental health with the same “esteem” as physical health. But in a letter to Earl Howe, then undersecretary of state for health, Healthwatch chief executive Katherine Rake said: “There would need to be a meaningful process of engagement with the public and a process of translating the mandate into an accessible format that would enable a productive conversation with the public.”

I searched several local Healthwatch websites and found some that are publicising the consultation (eg Oxfordshire, North Yorkshire, Leicestershire) and many others aren’t. Savvy pressure groups will rightly mobilise members to respond, like the Wheelchair Leadership Alliance that campaigns for better wheelchair provision across England. But most people won’t have any way of knowing that this chance to help shape the NHS exists.

And it doesn’t seem fair to blame Healthwatch for not spreading the word. The Department of Health wrote the mandate and invited us to respond. But it’s like one of those invitations that’s so low key you don’t realise you’ve been invited.

Related: George Osborne has 10 days left to save the NHS | Shirley Williams

Does it matter if we don’t engage with the “Five Year Forward View” outlined in the proposed mandate? Is there anything in it we need to object to? There’s a lot of good stuff in there. But you may want to add something that you feel is missing, like adequate wheelchair provision, or IVF services. You may have a view about seven-day a week GP provision. Or about the Cancer Drugs Fund.

The fact is, an invitation to participate is meaningless if you don’t know you’ve been invited. The government should either storm ahead with their five-year plan and stop pretending to involve us. Or ask us properly. We’ve got four days left to respond. Let’s do it.

Take part in the NHS mandate consultation