The announcement before Christmas that more than £40 million is to be spent on improving Cornwall’s hospitals and healthcare as part of major transformation plans is welcome news indeed, particularly that £9.1 million will be spent on projects to make improvements at West Cornwall Hospital, including the Outpatient Department and works at St Michael’s Hospital in Hayle so that all elective (non-emergency) orthopaedic surgery can be undertaken there in a bid to improve patient flow at Royal Cornwall Hospital in Truro.

By the time you read this, the NHS will have published its new 10-year plan based on additional funding announced in the summer of 2018. It is therefore perhaps a good time to look ahead to what the new plan might bring but to also reflect on the previous NHS plan from 2000 and its very different approaches to the public, the taxpayer and delivery of services.

The pillars of the last plan were certainly ambitious in scope and approach with previously unseen levels of investment allied with drives to improve and reform.

The government of the time made a case for investment in a better system with 10 agreed principles signed up to by many organisations following extended, meaningful consultation. For the first time ever quality and patient experience were very much in the mix and crucially, there was hugely increased funding to match the ambitions.

Tellingly, the plan was signed not only by the Secretary of State for Health but the Prime Minister himself. So, the message was clear – the objectives were driven from and endorsed by the very top of government.

Back at the turn of the millennium, the UK government was directly accountable for the NHS and people understood that. The centralised state basis for Bevan’s creation did not encourage local accountability – indeed, in many ways, it actually failed to countenance it.

Since 2012 however, we have strayed into a situation where the NHS is one step removed from government with decisions supposedly taken locally but sadly, with no local accountability. There is also a worrying lack of scrutiny as to where taxpayer’s money is being spent.

People will only continue to pay and support something they feel a part of and something which they have a level of influence over. Sadly, across the country, communities do not feel the same about the NHS as they once did. This fact alone should give government and NHS managers real cause for alarm.

With so many conflicting priorities and ever-increasing demands for funding from the Treasury, it is true that some MPs might feel that the NHS gets special treatment whilst other departments continue to struggle. This underlines the need for any additional funding to be well spent and the value of local communities understanding and feeling the benefits of such investment.

So, what criteria should be used to plan for using a resource which we already know is insufficient for the many claims upon it? The primary benchmark must be that the NHS should receive adequate funding to meet a clear set of objectives across the whole health and social care system for a given period of time.

We need to be serious about what service we want to deliver, what we are prepared to pay for it and how it works for patients. The taxpayers and patients themselves must be able to influence the way the system works.

Parliamentary debate about the additional money has so far gone quiet. Meanwhile local communities have simply not had the debate as to whether this is the best use of any additional funds when we witness the state of local schools, cuts to Local Authority budgets or people turning up at MPs surgeries at the sharp end of austerity.

At the moment we are in a situation where nobody knows who is accountable. This is simply not acceptable in a system which is bound up with so much public investment and seeking to secure even more. Obviously, any additional funding is welcome but if government is serious about supporting the NHS and social care for the long term they need to be clear on where the money is going and trust local people to have a say.