Earlier this week the UK parliament voted that the secretary of state for health will have new powers to close any hospital in England, should he see fit. There are a couple of caveats attached. Firstly, the local people will apparently have ‘a say’ and the local commissioning boards of GPs will also have to agree. How much of ‘a say’ local people will really get is yet to be seen and how much pressure will be exerted on local commissioning boards to tow the party line we don’t yet know.
What this highlights yet again is the complete lack of joined up thinking that happens around healthcare and the wider economy. It also reveals how utterly disempowering central government really is. How can Westminster decide what the needs and wants of the city of Leeds are, for example? What do they know about the non-economic impacts of closing a hospital? I’m not arguing that all hospitals should stay open, and there’s a good chance that some may well need to close. But it cannot be a decision from on high. Nor can it be an isolated decision. It’s too complex for that.
I find great encouragement from the knowledge that there are several towns and cities in the UK where ‘a people’s assembly’ is emerging. There are some stunning examples of this in Nottingham, Leeds and London. Across a city such as these ones, there are webs of networks and interconnected relationships that represent thousands and thousands of people. I had the utter privilege recently of spending some time with John Battle, a recently retired MP from Leeds. He carries a wealth of wisdom in understanding how to engage people from across a city to participate in key decisions. He was explaining to me that in a people’s assembly, there are representatives from many groups across the city. Each person can speak on behalf of their group and report back to them for further discussion. It’s an incredible way of involving a huge proportion of a city in a discussion.
In Nottingham, for example, at the time of electing the new police commissioner, over 1200 people, representing a vast number of networks, gathered from across the city to have a facilitated conversation about what they would hope for from their new commissioner. They were then able to ask questions to the four candidates, and were able to set up a system of accountability for the eventually elected commissioner back to the people. The commissioner understood in no uncertain terms that he was there to serve the city and the city understood that it was there to partner together with the commissioner for the welfare of the communities living there.
A facilitated conversation gives voice to everybody and sets no-one up above another. Leadership becomes about facilitation rather than dominance and control. When we talk about closing a hospital or a maternity unit or a school in an area, it is often said (as in my previous blogs) that there are some very complex things to consider. This is absolutely true. The problem is that we don’t share the complexity, we leave the decisions to so-called experts (who are at best having a good guess), and then either make them heroes or scape-goats!
National budgeting doesn’t work when it comes to healthcare. Local budgeting in isolation doesn’t work either. It’s all well and good to campaign to keep a hospital open, but we do actually live in a world of finite resources and people and so if we keep the hospital, there may be other tough cuts to make. We have separated out huge aspects of budgeting that really belong together. That is why a people’s assembly in a town/city/region doing the complex task of participatory budgeting is a possible way forward. It isn’t actually that difficult to get people together and budgets aren’t that hard to understand. I know so many people who have extremely tight and complex budgets to manage when it comes to their own households and they do it with finesse. Multiplying the numbers up, ain’t that tricky.
When a town/city understands what it’s budget is for a year (or longer) and the people can decide what the priorities need to be I think the results could be amazing. Firstly, there might be genuine partnerships formed across cities to work in more innovative and creative ways. Secondly, there would be greater engagement and social responsibility. Thirdly, there would be less waste. Fourthly there would be emerging partnerships of gift (rather than competition) between cities for various resources.
Some argue that in such a situation, the most needy and therefore least empowered in a city could miss out. This happens currently in the national setting. For me, this is where leadership comes in. Leadership is not about riding into town to shut a hospital here, or rename a school into an academy there. Leadership is about emptying power out and reassuring all that they are already empowered. It is also about helping protect and promote those who could potentially be down trodden or forgotten. It is giving a voice to those who feel voiceless and oppressed by the dominant systems. For me that would mean promoting and protecting the needs of women (for whom there is still an incredible amount of injustice), children, asylum seekers and refugees, the marginalised poor and homeless, those with physical and mental health needs and prisoners.
Power needs to be devolved from the centre to the margins (just as Gordon Brown MP stated this week). And once the power is more regional it still needs to be continually emptied out so that communities find and serve one another, so that cities become gifts to one another and we find that the order of the house (economics) is the responsibility of all.