Is Andy Burnham the new Lansley? 26 March 2015 For the second time in five years we are on the cusp of having a new health secretary with a compelling vision for the NHS. In 2010, Andrew Lansley’s vision was to push managers aside and put “family doctors” in charge. In 2015 Labour’s Andy Burnham is offering the equally beguiling vision of “whole person care”. Both men have firm views about who should supply NHS care. For Lansley, competition and choice would bring market rigour to the statist health service, driving out poor clinical quality as GP commissioners reshaped care pathways around the needs of patients. Burnham is equally certain that NHS care should be provided overwhelmingly by the state and wants to rig the rules against private companies, making the NHS the “preferred provider” and only offering private firms short contracts. Read the full article on the Guardian Healthcare Network __________________________________________________ Vanguards put the Forward View on trial 13 March 2015 NHS England’s announcement of the vanguard areas for developing new models of care means the Five Year Forward View is now on trial, with many dangers ahead. The goodwill towards the vanguards programme is striking. The scale is impressive, with the potential to improve services for up to five million people. The salesmanship of NHS England chief executive Simon Stevens has convinced the service that this is the beginning of widespread, patient-centred change, not yet another wave of pilots. The vanguard areas will join up mental health, primary care, community nursing, hospitals, pharmacy and social care. Nine of the 29 successful bidders are primary and acute care systems, while 14 are multi-specialty community providers (GP practices coming together with hospital specialists, community services, nurses and pharmacists to offer primary and specialist services). It is the remaining six – aiming to enhance health in social care – that provide the most convincing evidence the NHS leadership is thinking about the care system as a whole rather than simply the NHS. Read the full article on the Guardian Healthcare Network __________________________________________________ Manchester plan will affect entire NHS 27 February 2015 Chancellor George Osborne’s announcement that the entire £6bn health and care budget for Greater Manchester is to be handed over to local control has repercussions for the whole NHS. It opens up a new front in national and local moves to overhaul the funding system, regulate systems instead of organisations, make services locally accountable and to breach the wall between social care and health. While many people in the NHS dislike the idea of direct local government control, local politics has always been a powerful influence on reconfiguration debates. The NHS compares poorly with councils when it comes to making tough decisions about services, and many politicians and council managers are angered by the way NHS trusts run up uncontrolled deficits – something that is not tolerated in town halls. Perhaps local government will have the courage to take decisions that seem so difficult for the health service. A major weakness of the Manchester plan could turn out to be the complicated governance arrangements. The details will not be finalised for many months, but from April 2016 a Greater Manchester strategic health and social care partnership board will set the direction, while a joint commissioning board bringing together representatives of NHS England, the 12 clinical commissioning groups and 10 councils will make decisions on services affecting the whole city region. Read the full article on the Guardian Healthcare Network __________________________________________________ Why would doctors become managers? 24 February 2015 The job of NHS trust chief executive almost seems like it was designed to dissuade doctors from applying. It requires a consultant to ditch their job security, probably earn less money, be saddled with problems they don’t have the power to solve, and risk public humiliation and professional ruin. As Hugo Mascie-Taylor, medical director at NHS regulator Monitor and former special administrator at Mid Staffordshire Foundation Trust, puts it, “I’m not saying you have to change the nature of the role, but we have to recognise that as it stands it does not attract doctors.” The fate of Mark Newbold exemplifies the risks that doctors take if they enter senior management. In November he was left with little choice but to resign as chief executive of Heart of England NHS Foundation Trust after Monitor had raised the prospect of forcing a change of leadership over waiting times and concerns over mortality rates. Read the full article at BMJ.com __________________________________________________ Forward View must have clinical buy-in 19 February 2015 As the implementation phase of the NHS Five Year Forward View begins, the whole programme risks falling victim to its own early success. It has been so well received that too little attention has been paid to selling the message to clinical staff. At the King’s Fund on Wednesday, NHS England chief executive Simon Stevens revealed that there have been 268 applications to become “vanguard” areas, developing new models of care such as multi-specialty community providers (MCPs) and integrated primary and acute care systems. Fifty hospital systems want to form integrated organisations funded with a capitation budget, while 170 GP-led consortia want to expand into secondary and community care services, some in collaboration with hospital consultants. Intriguingly, applicants will get a chance to comment on each other’s bids, in what Stevens likened to a Eurovision-style process, to maximise the chances of selecting sites which are going to provide the most useful models for the rest of the country. Read the full article on the Guardian Healthcare Network __________________________________________________ English councils need powers to survive 18 February 2015 The independent commission on local government finance has proposed a radical programme of English devolution, arguing that local government in England is no longer sustainable in its present form. The commission’s final report, which I helped draft, seeks to capitalise on the momentum towards devolution created by the Smith Commission proposals for Scotland, the powers negotiated with the government by the Greater Manchester Combined Authority, and the backing for devolution to local government from the leaders of all three main political parties. As prime minister David Cameron has said: “The debate now is about how far and fast it can go.” Despite its radicalism, the commission’s report is a practical programme for reform in the next parliament, not a wish list. It shows how empowering local government would help ministers achieve national goals such as building more social housing, intervening early in troubled families and matching skills to the needs of businesses. It also tempts the parties with a way to break the paralysis around reform of local government taxation by devolving property revaluation and the setting of council tax bands, as well as with the long-term prospect of extricating themselves from the detail of funding allocations to individual councils. Read the full article on the Guardian Public Leaders Network __________________________________________________ Parties line up election promises on NHS 18 February 2015 The emerging health policies for the main political parties reveal sharp differences in content and presentation - yet all three fail to offer a convincing plan for change. Labour’s policy is laced with anti-private sector rhetoric and makes ambitious promises on everything from cancer tests to staff recruitment. The Liberal Democrats, meanwhile, have allied themselves to NHS England’s Five Year Forward View by promising to meet the £8bn funding gap it identifies, while placing its health policies in the context of wider public sector reforms and increased local control. The Conservatives don’t want to fight on this territory at all; their interest is in closing down debate on the NHS and focusing on the economy. Health does not feature in their top six election priorities. Labour’s 10-Year Plan for Health and Care, launched in January, is built around its opposition to competition for NHS contracts, an issue it highlights 20 times. In government, the party would repeal the Health and Social Care Act 2012 in the first Queen’s speech and block most use of the private sector by replacing competition with an “NHS preferred provider” policy. Read the full article on the Guardian Healthcare Network __________________________________________________ Trust chiefs prepare for decision time 12 February 2015 The chaos of the winter pressures is an important start to what promises to be a turbulent year for the hospital sector. It will be marked by tough decisions about viability and reform, a move from competition towards cooperation, changes to the medical workforce and a search for whole system solutions encompassing primary and social care. More decisively, the exceptional winter has guaranteed that the health service will be at the epicentre of the general election campaign. John Drew, head of the McKinsey Hospital Institute, sees the election as a dividing line in the year for health. He says: “The first half of the year will be about performance targets around [accident and emergency] and money, because the NHS will be a key battleground. “Before hospitals can focus on anything strategic they will be dominated by operational issues.” Read the full article at Health Service Journal __________________________________________________ Clinical commissioning risks losing way 5 February 2015 Clinical commissioning is in urgent need of a new sense of direction and purpose as it faces the spectre of yet another round of reorganisation after the general election. Research by the Nuffield Trust and the King’s Fund into the workings of clinical commissioning groups (CCG) concludes that the future of the clinical role in commissioning “remains fragile”. Interest from CCG leaders is waning, and they do not have the time, money or management support to do their jobs properly. While the media is inevitably focused on problems in hospitals, the commissioning system is also under unsustainable pressure. They have always been under-resourced, and now many of them will be “co-commissioning” primary care from April with no extra cash or staff after NHS England ruled there is “no possibility of additional administrative resources” for taking on that role. Instead CCGs have been helpfully advised to adopt “pragmatic and flexible local solutions” to running primary care commissioning, which presumably translates as overstretched staff teams taking on more work. Read the full article on the Guardian Healthcare Network __________________________________________________ New battlefront opens up for managers 22 January 2015 The revelation that a group of campaigners has made a complaint against more than 20 managers to the Care Quality Commission (CQC) under the “fit and proper persons” test opens up a new reputational battlefront for health managers. According to the Health Service Journal and Nursing Times, the complaints are aimed at current and former chief executives, medical directors, senior executives, and a former nursing director. The fit and proper person test was introduced under the Health and Social Care Act 2008. While much of it revolves around predictable criteria such as bankruptcy and criminality, it is an amendment in 2014 to the regulations implementing the act – regulation 5 – which exposes senior managers to many risks. The amendment was made in response to the Winterbourne View hospital scandal and the recommendations of the Francis inquiry into Mid Staffordshire foundation trust. It says that a director must not “have been responsible for, been privy to, contributed to or facilitated any serious misconduct or mismanagement (whether unlawful or not) in the course of carrying on a regulated activity”. Read the full article on the Guardian Healthcare Network __________________________________________________ Trusts are facing tough survival choices 8 January 2015 Many trusts have already failed in their first aim for 2015 – to keep out of the election campaign headlines. But the sheer number of trusts taking emergency measures such as opening extra beds is now so large that it has become more of a badge of honour than a reason for regulators to begin investigations. Nonetheless, the brutality already evident in the tone of the political debate in the run-up to polling day means trust leaders are more sensitive than ever to incidents that could put them at the centre of a national controversy. That thinking will dominate the next four months. Once the election is over, 2015 will be the year when dozens of trusts will be compelled by their unviable finances to make tough choices about the future. For many, this will entail being pushed into the new “success regime” for struggling health economies overseen by NHS England and the regulators, leading to what might be described as guided choices about what to do next. Read the full article on the Guardian Healthcare Network __________________________________________________