Health and social care must be taken out of the reach of politicians with short-term horizons by establishing a Health and Social Care Policy Committee (HSCPC) with a remit covering not only the NHS, but crucially other health and social care as well (which the NHS has been demonstrated to depend on during this pandemic). This is critical for 3 reasons:
1. To enable truly long-term planning within the system
2. To facilitate a joined up approach between health and social care
3. To encourage the underlying causes of increased demand for services to be addressed
Central government making decisions with the goal of a perceived short term benefit to the detriment of longer term goals is nothing new. In the 20th century, countries were wrestling with the best way to manage inflation through their monetary policy, and the solution, put in place by the UK in May 1997, was to assign the role of managing inflation to the Bank of England through the Monetary Policy Committee (MPC).
The MPC work within a framework set by Government but independent of daily politics and elections. By utilising appointed monetary experts who were (and still are) answerable to government, it became possible to manage inflation better than ever before. In the same way, a HSCPC should be established to address the long term needs of the system, free from day-to-day political influence.
Who should make up the HSCPC?
• Similar to the MPC there should be one Governor chairing, assisted by nine Deputy Governors.
• Deputy Governors should include: Finance, Medicine, Nursing, Chief Operating Officer, as well as additional individuals required for: future proofing the system (Epidemiology & Public Health England representatives), a seamless transition (Chief Executive of the NHS Confederation) and social care provision (representatives from social care).
• By including social care within the HSCPC, it will allow the underlying causes of increased demand within the NHS and wider services to be addressed, whilst also managing the provision of services.
• It is important that the Governors chosen for specific areas of expertise e.g. epidemiology, medicine, nursing all have real world experience of delivering care within the system.
Who should select the committee?
• In keeping with UK systems, The Queen should appoint the Governor and Deputy Governors on the advice of the Prime Minister and the Secretary of State for Health and Social Care.
What should be the length of service for a Committee Member?
• MPC members serve defined terms before being re-appointed or replaced. Free from political influences and election campaigns, individuals are allowed the freedom to make decisions in the interest of their long term goals and, as established by the Higgs and Cadbury reports et al., consistency is achieved through collective responsibility to act in the long-term interests of the enterprise. The HSCPC should follow the same approach.
What should be the seniority of the members?
• A role on the HSCPC will place each individual in the public eye and under constant scrutiny. Change is never easy and there will undoubtably be some backlash. It is important that the role is seen as a step up for those in the field. The decisions the HSCPC will be making will (hopefully) save the Treasury significant amounts as they strive to make health and social care provision more efficient.
• The Committee will sit at the top of the Department for Health & Social care, but it’s important to stress that it will not replace the Health and Social Care Committee, who’s primary role it is to scrutinise the work of the Department of Health and Social Care and its associated public bodies.
• The government’s role will be to assist with panel selection and, through the Health and Social Care Committee, will also hold the HSCPC to account.
What powers should the HSCPC have?
• In the same way the MPC have the power to set the base interest rate and print money, so must the HSCPC have defined powers with which to effect positive change.
• The committee should advise HMG on immediate budget requirements as well as those for their long term plan, however setting the budget should remain in the hands of HMG and the Chancellor of the Exchequer based on what the country can afford. It will then be up to the HSCPC to make sure that budget is spent efficiently and appropriately.
• They will also lead the Department for Health and Social Care and should have the department and their powers at their full disposal.
Potential positive actions for the first 100 days:
1. Engage with NHS and Social Care frontline staff to get their ideas and buy in to the reform project
2. Utilise the experience from other areas of the public sector, such as the armed forces, to manage personnel post ‘conflict’ following an incredibly traumatic period for care staff
3. Improve understanding and awareness of the ever-increasing demand for health and social care services, and create a plan to address it
4. Promote the HSCPC as a way forward
5. Define the terms of reference for the HSCPC
6. Address the distorted and ineffectual performance indicator and incentive systems currently in place
This solution submission was reviewed and approved by:
Professor Peter Brownson
DM FRCS ED FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Honorary Professor University of Liverpool
Past President British Elbow and Shoulder Society
Emeritus Prof W Angus Wallace
Academic Orthopaedics, Trauma & Sports Medicine, University of Nottingham
Retired Consultant Trauma & Orthopaedic Surgeon, Nottingham University Hospitals NHS Trust
International Board of Shoulder & Elbow Society – Shoulder and Elbow Pioneer 2019
Chair, Event Organising Committee, Faculty of Clinical Informatics UK (2019-21)
1559-11