We had a brief discussion during the Health and Social Care Bill committee last night about whether the new healthcare economic regulator, Monitor, will meet in public. It will apparently. I have always supported having meetings in public and chosen to have them in public whenever there was a choice. But I have realised over the years that public meetings tend only to make decisions that have been previously debated in private. If a public body has public board meetings it will have ‘briefing meetings’ or ‘seminars’ in private where the main business is thrashed out and deals are done. Health Boards are not local authorities with ‘representatives’ shouting for their corner; they are corporate bodies making joint corporate decisions that everyone has to sign up to and be accountable for. Private dissent is too often buried in the urge to be seen to have a united front in public.
Transparency and full public accountability appear to be strengthened by public meetings but are often not. Board behaviour is affected by the presence of the public; the level of challenge and scrutiny is diminished and behaviour tends to be more compliant than in private. There are also major anxieties about raising patient safety issues and discussing serious untoward incidents, for fear of producing public alarm. Decisions that should be taken by the board have a tendency to get sorted out in private sub-committee meetings when it would have been better to have full discussion with the main board.
On the other hand public meetings increase public trust and understanding of the issues and there’s no doubt that the quality of reports are improved when they are going into the public domain. Business sensitive and patient confidential matters can be reserved to private parts of a meeting from which the public is excluded. As so often a fudged position is probably the best…the Chair has a responsibility to ensure that dissenting views are expressed to a wider audience and worked through in the public arena but should make sure they know the outcome of a decision long in advance!