NHS "listening events" - Flip chart 'democracy'

NHS Unite rep

About 120 people gathered at the Manchester City stadium for the NHS "Listening Event" - we seemed to be a mixture of NHS managers, health workers, voluntary sector and community activists.

The chief executive of NHS North West spoke about making progress on getting Trusts to Foundation status and getting GPs into consortiums. He handed over to the chief exec of Yorkshire and Humber strategic health authority who has a place on the 'Future Forum' (the Listening Panel). He assured us the event was genuine and that the panel is completely independent.

When they asked for questions, mine was: "If the government set up the panel, set its terms of reference, picked the members, and can decide which recommendations to accept or ignore, is it really independent?" They answered that there are no terms of reference and the panel has a wide range of people involved, not just managers.

Plenty of other people then came in with questions. One asked: What about Mark Britnell, now head of health at management consultants KPMG and former NHS adviser who had said: "No mercy for the NHS"?

Questioners said these changes were not in the manifesto, why is this even happening, no one even said the problem was the structure of the NHS, - we pensioners have not been consulted. The reply was: "Good points, put it all in the process."

We then broke up into tables to discuss one of either "Choice and competition", "Education and training", "Clinical advice and leadership to improve patient care" and "Public accountability and patient involvement", although you were invited to comment on any other issues if you wanted.

When the tables reported back there was universal and harsh criticism, except for one table which seemed to have some high-ups from the voluntary sector.

The many points made included: Why chase "choice" not quality? Private medicine will pick the easy cases. The changes are disruptive and will cost a lot of money. Patients cannot really choose based on quality, they just want a good service locally. Services will lose integration. Staff will be trained, but there could be no jobs to go to and PFI is a huge waste and ultimately unsustainable.

So the comments were overwhelmingly critical, honest and well-informed. But then 'mine host' came in with the four 'high level themes' that he said had come out of the meeting:

The communication of the need for so much change so quickly has been poor.
Trust is the key to the NHS, and the Bill risks damaging that trust eg in GPs.
Danger of fragmentation, concern at role of Monitor if it is to promote competition.
And the loudest message - we all share a passion for the NHS. The views coming are "not political", they are sincerely held and based on experience.

This was not an accurate reflection of the tone of the event. It was an exercise in the "flip chart democracy" so familiar in the modern workplace. Everyone says what they want, but the person at the flip chart decides what to write down, and when they take the chart away they can edit it as they want, all the time claiming "You were all there, you all had a say."

Fortunately, just as we were being thanked for our trouble Paul Foley, North-West head of health for Unison, stood up and stated the obvious fact that the summing up did not capture the views expressed: "The message is - these proposals need to be changed in a very fundamental way."