Campaigners in the business of influencing public services will soon find the world turned upside down. One of the defining features of the Coalition– its intention to shift power from central government to local government and communities – is prompting big changes. Campaigners need to understand those changes and how to respond to them. Tried and tested campaign tactics will cease to yield the results they once did. The localism agenda is reshaping the campaigning environment and if you don’t change with it, you will find yourself without influence.
To take just one example, the NHS reforms require campaigners for better health treatments and services to adjust their tactics. Merely lobbying Westminster and Whitehall is no longer going to cut it – if it ever did – if your goal is to influence the quality of NHS services in England.
The NHS reforms are complex and I don’t claim to be an expert on them. I do however have a basic grasp of the proposals and a view as to how the reforms might impact on the way campaigners influence health policy and practice. The details of the reforms are a bit dull and full of the usual jargon but bear with me while I sum them up in a few sentences.
You could argue that the ‘N’ in NHS is about to be replaced by an ‘L’ for Local.
In future, the new NHS Commissioning Board – not the Department of Health – will be responsible for delivering clinical outcomes. The Outcomes Framework will describe the relatively few indicators by which the performance of the NHS is measured. NICE Quality Standards will set out what a high quality service looks like but will not be binding. Local GP-led clinical commissioning groups (CCGs) will be responsible for buying in services for the local population. Local Health and Wellbeing Boards will have the power to scrutinise local health services and a duty to involve local service users and the public.
No doubt there will continue to be a role for charities to influence at national level – for example by feeding into the development of NICE Quality Standards – but it seems to me that campaigners will need to adjust their tactics to have real impact on the lives of the patients and service users they represent. There will be a much greater need to lobby at local level – in particular to engage with commissioners – to secure the best possible treatment and services.
How can charities do this? The key is patient power – empowering and mobilising people at the grassroots to advocate on their own and others’ behalf for the type of services they want. In an NHS in which patient choice is increasing and local commissioning groups have more freedom to decide which services to buy for local people, health campaigners need to decide how they will leverage patient power to influence which services are commissioned and to what standard.
In my former life at Breakthrough Breast Cancer we created the Service Pledge to enable partnership between nurses and patients to improve local breast services, guided by Breakthrough’s gold standard. Breakthrough trains advocates who have recently been treated for breast cancer to present the template Pledge to local hospitals and persuade nurses and other clinicians to ask patients what improvements they think need to be made. Clinicians sign a locally-specific version of the Pledge setting out the standards they will meet and the improvements they will make. The Service Pledge led to many small but important changes – many of them cost-free – to local breast cancer services and is still going strong.
Right now the NHS is in flux and it won’t be possible to fully assess all the changes until the Health and Social Care Bill has completed its passage through Parliament and implementation begins. The Localism Bill gives greater power to local authorities to control how public services are delivered in their areas and will affect housing, social care and other services overseen by local government. It’s clear that the public services landscape is changing and those charities with an interest in securing the best possible services for the people they represent need to reappraise tactics to ensure they are fit for purpose.
The people who donate to your charity, sign petitions and email MPs need to be supported and trusted to be the local change makers. This means devoting more time and resources to facilitating local campaigning by volunteers – a challenge in the current economic climate but one that must be faced.