The row over NHS treatment of the elderly shows up the limits of localism

By Paul Goodman
Follow Paul on Twitter

Last week, the Daily Mail reported that David Cameron intends to improve the treatment of older people by the NHS by ensuring that the following measures are implemented:

• Nurses will carry out hourly rounds of their patients.
• Every NHS ward will have a "dementia champion".
• There will be a "friends and family test" of the standard of care in NHS institutions.
• Every NHS organisation will have a "dementia nursing expert".
• "Nurses and midwives at the beginning of their career will be given the opportunity to become 'care markers', a new initiative to use volunteer ambassadors in hospitals and homes to improve care."

Today, Jeremy Hunt writes in the Sunday Telegraph that he intends to improve the treatment of older people by the NHS by ensuring that the following measures are implemented:

• A "friends and family test".

He also says that:

"...the best [NHS institutions] know that no box to be ticked, no target to be met, no initiative to comply with is worth a single failure in care"

- and -

"A culture of targets and performance management defined the NHS under Labour - with the unintended and tragic consequence that organisations cared more about meeting top down targets than focusing on the needs of patients."

You can see where this is going.

I'm sure that the Health Secretary is fully lined up behind the dementia champion, dementia nursing expert and care marker plans, but it's suggestive that he doesn't mention them - but does criticise Labour's targets and performance management culture in the NHS.

The difference of emphasis between Messrs Cameron and Hunt helps to highlight the shift from localism that's taken place within the Conservative Party since it moved from opposition to Government.

I don't mean that there's been no localism at all: actually, there's been quite a bit - see Harry Phibbs's list this morning of 100 Coalition Achievements and, for example, numbers 1, 2, 3, 48, 49, 50, 51 and 52.

But the full-blooded localist agenda set out in Direct Democracy and The Plan hasn't come to pass.  One of the main reasons why this is so is being demonstrated by the backlash over the treatment of the very elderly by the NHS.

What happens is as follows.  First, a public service scandal is brought to light.  Next, there's a media and voter outcry.  Finally, the Government pledges to "step in".  This is exactly what is happening during the run-up to the Francis Report.

In opposition, the Conservative plan was to title the Health Secretary the Secretary of State for Public Health, and to devolve NHS management to the new NHS management board.  This happened: Andrew Lansley stressed the public health part of his title when appointed.

The purity of this approach has been compromised by the stresses of government. The Department of Health website describes Hunt simply as the Secretary of State for Health, and doesn't list public health among his responsibilities.

As it happens, Hunt is an enthusiast for localism, and one of the original supporters of the Direct Democracy manifesto.  He knows that a centrally-driven requirement on nurses to carry out hourly rounds of their patients can degenerate into the box-ticking that he deplores.

My own view is that since national government is accountable to voters for taxpayer-funded public services, it cannot escape responsibility for them - not, at least, until there's much more local funding of local services, and that isn't on the cards at the moment.

So it is that Michael Gove will help to shape the exam system, Theresa May will have a hand in determining how the police force works, Owen Paterson must have a plan for flood defence - and Hunt will set the priorities of the health service.

As Tim Montgomerie has reported, the Health Secretary wants to help lead a patients' and relatives' insurrection against institutional NHS complacency or callousness.  I wrote recently that we ought to be much, much more angry about hospital treatment of the very elderly.

So I support most of the measures that the Prime Minister set out, though I don't believe for a moment that central Government can micro-manage the nursing of wards.  (And if hourly inspections by nurses aren't the norm in any event, why not?)

But as Hunt writes today:

"Most of all we need a change of culture. Patients must never be treated as numbers but as human beings, indeed human beings at their frailest and most vulnerable."