Editorial Wednesday 11 December 2019: At the eleventh hour and fifty-ninth minute, some Labour health policy

This is quite interesting. Labour's shadow health secretary Jonathan Ashworth has finally given Health Service Journal an interview about Labour health policy.

Both HSJ's editor Alastair McLellan and I have spent almost two years trying to get this interview done, and it evidently wouldn't have happened but for a newly-demob-happy Mr Ashworth realising the consequences of his ill-judged phone call with a Tory 'friend'.

Which does not say great things for Labour's confidence in its deliberately, thoroughly vague health policy. Triangulating between NHS 'privatisation' conspiracy theorists (PCT) and members of the reality-based community (RBC) never was going to work out well.

But there we go: that's politics nowadays.

So let's move on to the actual ideas in the interview. The big one being making Integrated Care Systems (the new regional units of NHS planning to RBC members, and privatisation vehicles to PCT members) "democratically accountable".

The what, they why and the how
When we look at any new idea (the 'what'), we have to look at the 'why' and the 'how'.

'Why' is straightforward: this regeneration of the Labour Party (Jeremy Corbyn = Sylvester McCoy) believes there's a strong appetite for greater local democratic accountability and control.

The 'how' bit of this policy proposal  is, of course, unexplained. Which actually does matter, beyond healthpolicyland. ("There is a world elsewhere" - Coriolanus.)

ICS have something in common with NHS privatisation: they, too, are fictional.

The ICS concept is 2019's health policy Santa Claus: it only exists because people agree to believe in the fiction.

ICS are best understood as relationships: they are (at best) a regional agreement to co-operate and plan. They're also a corrective to the warm fantasy that an NHS  inadequately funded to meet rising demand would work better with competition/market drivers.

So is it a good idea that ICS should be democratically accountable?
Well, presumably firstly we would want them to actually exist in the reality-based community.

At present, ICS are every bit as fictional as NHS privatisation. Now clearly, a majority Labour government could legislate ICS out of the fictional realm and into the reality-based community.

That would make ICS actually legally and statutorily exist. Once they do, they could, somehow, be made democratically accountable.

Would that help? And if so, how?

The absent precedent
Let us briefly consider the precedent in having democratically accountable NHS/health and care regional planning bodies. I say 'briefly' because there is no such precedent. ('The Precedent's Brain Is Missing').

All of the previous region-wide planning units - be they NHS regions, regional health authorities, district health authorities and strategic health authorities - had one thing in common: no significant direct democratic accountability.

They were, like the accountable officers of NHS organisations, in a line management accountability role to the Secretary Of State For Health.

It was a very centralised, command-and-control way to run a system. It demanded production of 'the right answer' and 'no noise that will embarrass the SOS'.

And it contributed massively to the toxic bullying and cover-up culture that is present in the NHS.

You would want to think very, very long and hard before an NHS Reinstatement Bill that went back to that. And having thought long and hard about it, you'd want to not do it.

Next up, ICS include local authorities, which are elected. That's pretty democratically accountable.

One of the challenges for ICS is that many of the include multiple local authorities, of different political complexions.

So you'd have to reconfigure all ICS to be coterminous with local government/authority boundaries, which would be one heroically hilarious redisorganisation.

That would waste every scrap of effort that has been put into them. Because we have to come back to the key point about what ICS are: they are agreements co co-operate and plan.

The essential point of ICS, as I have previously written, is that they are partnerships and relationships.. That is what voluntary agreements to co-operate are.

If you believe that making partnerships/relationships/voluntary agreements to co-operate 'democratically accountable' will be an improvement, then you need to think further about it.

And keep on thinking about it until you decide you're not going to do it.

Because it is a bad idea, and will not help.