LATEST ARTICLES
Clinical commissioners find it
tough
13 December 2012
The authorisation of the first clinical commissioning groups
provides a window onto the state of readiness of the new NHS
structures.
With less than four months to go before the CCGs formally
take over from primary care trusts, just eight out of the 211
have now been fully authorised by the NHS Commissioning
Board to begin their work. After a gruelling five-month
assessment against no fewer than 119 criteria, a further 26 of
the 'first wave' CCGs have been authorised with 'conditions'.
In a phrase redolent of Mao's Cultural Revolution, these
deviants from the true path have been told to establish a
'rectification plan'. Some of the conditions amount to little
more than adhering to a piece of guidance, but the problems
in nine of the CCGs are serious enough for the board to insist
on signing off remedial work.
Three more waves of CCG authorisation will follow in the new
year. Many of the CCGs beset by the most serious problems
are in those waves, so it is worrying that the first wave showed
significant difficulties with basics such as having credible
finance and service plans and effective governance.
Read the full article on the Guardian local government
network
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Ministers sideline council
economic role
7 December 2012
In the autumn statement, it is not just the additional £445m
cut in 2014-15 and the promise of more to come that is bad
news for local government. It is that the analysis of local
government's predicament and role bears little relation to
reality.
The document accompanying the autumn statement says that
the fact councils have been spared additional cuts in 2013-14
"provides an opportunity for local authorities to invest in
reform in order to deliver further savings by consolidating
back-offices and transforming service delivery, as
demonstrated by the Whole-Place Community Budget pilot".
This is dishonest. As the New Local Government Network has
demonstrated, even if councils' "back office functions" (you
know, those wasteful bits that have nothing to do with service
delivery) cost precisely nothing, this would still not get local
government finances out of its current hole.
Read the full article on the Guardian local government
network
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Coalition’s NHS problems are
mounting
30 November 2012
The state of the NHS after the first half of the coalition
government is becoming clearer – but the future is
increasingly murky.
Two detailed studies – the CQC's State of Care report
published last week and the King's Fund's assessment of the
coalition's health performance at mid-term released on
Wednesday – paint a picture of a service under strain but not
yet in crisis. What is missing is reassurance that government
policy will make things better rather than worse.
The reports emphasise that the NHS is extraordinarily resilient
under pressure, but is slow to change.
Treatment waiting times are broadly stable since the coalition
came to power, although there has been a sharp rise in A&E
waits. Improvements in cancer and stroke care continue.
Deaths from cardiovascular disease have been falling sharply,
although there is still a geographical lottery in access to
treatment.
But the NHS has still not got a firm grip on patient safety
despite years of political pressure and professional focus.
While infection rates continue to fall, the scandal of avoidable
weekend deaths continues. NHS London believes 500 fewer
people would die each year in the capital alone if this problem
was dealt with. That could equate to several thousand across
the country.
Read the full article on the Guardian healthcare network
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Pickles starts to lose his grip on
policy
23 November 2012
Significant cracks are opening up in local government's
finances. The sector's optimism and can-do attitude cannot
disguise the fact that some councils are beginning to sink –
and it is putting pressure on Eric Pickles, the secretary of state
for communities and local government.
The implosion of West Somerset district council coincides with
an Audit Commission study that reveals more than a third of
councils are showing "financial stress". Meanwhile, research
by Local Government Chronicle indicates that up to a half of
councils could reject the government's council tax freeze.
West Somerset is holding crisis talks with the Department for
Communities and Local Government after revealing that it is
heading for a finance gap of 26% of net expenditure by
2019–20.
A Local Government Association report has highlighted the
option of the Boundary Commission reviewing the size and
shape of the districts in the area, but neighbouring authorities
have been decidedly lukewarm on the proposal.
Those close to the talks hope the prospect of a new nuclear
power station being built at Hinkley Point will start to make a
takeover look more attractive.
Read the full article on the Guardian local government
network
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Hunt dumps targets in NHS
mandate
15 November 2012
The first NHS mandate, which sets out the government's
expectations of the health service to the NHS Commissioning
Board, hardly represents freedom for managers and clinicians
but it at least has the feel of moving to an open prison.
After several months of consultation, the final document
identifying the priorities for 2013-15 wisely dumps the targets
proposed by Andrew Lansley in favour of a focus on
improvement. This is more than mere semantics.
The health secretary, Jeremy Hunt, realised that piling more
targets on to the NHS would have all but compelled the
commissioning board to micromanage the clinical
commissioning groups, crushing one of the central objectives
of the government's reforms. This way there is at least the
hope of more local autonomy.
Read the full article on the Guardian healthcare network
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Local power is key to economic
growth
9 November 2012
Local government’s role in economic growth is being reshaped
by four developments, two inside parliament and two outside.
The Local Government Finance Act gained royal assent last
week, incentivising councils to grow their local economies by
allowing them to retain new business rates. However, the
scheme is hedged with a mass of regulations, such as the
complexity of the safety net to protect councils whose
business rate income plummets, so the likely benefits of the
scheme are far from clear.
In addition, it remains to be seen how different types of
authority will be affected when the new funding system for
councils collides with the next round of spending cuts.
Read the full article on the Guardian local government
network
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Public health directors face
pitfalls
1 November 2012
It is becoming increasingly clear that public health directors
will need to exercise fine political judgment if they are to
thrive in their new position dangling precariously between
central and local government.
In some councils their first job may well be to cut services.
There are serious concerns that a toxic combination of the
wrong amount of money being transferred from primary care
trusts, and the new budget holders being locked into large,
long-term contracts on everything from dental health
promotion to health checks, means that once the money for
statutory services is taken out local priorities such as tackling
child obesity could suffer.
Then there is their position in the council. The government has
sensibly shied away from being too prescriptive about where
public health directors should sit in the local authority
hierarchy. It has not stipulated that they must be on the
corporate management team, but says they must have "direct
accountability" to the chief executive.
Read the full article on the Guardian healthcare network
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The council role in austerity
Britain
19 October 2012
Is local government ready to let go? Chief executives and
senior managers gathering in Coventry this week for the
annual Society of Local Authority Chief Executives (Solace)
conference were attempting nothing less than to redefine the
role of councils for an austere, digital and networked world.
The message that emerged was we must surrender control
and embrace collaboration. The dress code was strictly hair
shirt. Delegates checked into cheap hotels where the
reception desk doubled as a bar and there was one iron for
100 rooms.
At this year's conference, I detected a widespread belief that
the era of direct service provision was giving way to councils
harnessing the "energy and assets" of local people. Historically
dubious claims that we are experiencing a time of
unprecedented scale and pace of change have given rise to
worries that councils risk sidelining long-term planning in the
face of perpetual short-term crises. Others simply fear that
authorities are poorly equipped to shape or harness this new
world.
Read the full article on the Guardian local government
network
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Foundation restructuring is
inevitable
18 October 2012
Healthcare managers will be gathering for the Foundation
Trust Network conference next week at a time of growing
confusion as to how the health reforms are going to operate.
The health secretary, Jeremy Hunt, appears unwilling to read
from the script that Andrew Lansley left him. There are strong
indications in his first few weeks that he does not recognise
the wall that is being erected between the politicians and the
NHS under the new regime, and is repeatedly pushing into
territory which Sir David Nicholson and the NHS
Commissioning Board regard as theirs.
And, just as the new minister starts behaving like an official
with operational control, Nicholson has been behaving like a
politician. His recent comments to a conference of GPs were
extraordinary. He said: "Big, high-profile, politically driven
objectives and changes like this almost always end in misery
and failure." He is right, of course, but it is all but
unprecedented for someone of permanent secretary rank, in
effect, to ridicule government policy in this way.
Read the full article on the Guardian healthcare network
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Labour must develop a localist
strategy
5 October 2012
Anyone hoping for a coherent local government plan to
emerge from Labour's conference will have been disappointed
but shadow ministers did flag up major new council powers
over health and transport.
The conference was dominated by economic issues and Ed
Miliband's second coming, but there was little space for a
philosophical debate on the nature of an over-centralised
state. Local government's low profile in discussions on how to
revive growth was a worrying sign that it is in the margins of
Labour thinking.
The biggest, if sketchy, local government news to emerge from
Labour's party conference this week came from shadow health
secretary Andy Burnham. He said he was beginning to
examine the option of "full integration" of health and social
care, sees hospitals having a major responsibility for social
services, and wants local councils to replace clinical
commissioning groups as the lead commissioners of
healthcare.
Read the full article on the Guardian local government
network
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Labour cannot pursue quality
and ideology
4 October 2012
The shadow health secretary, Andy Burnham, is planning
another huge shakeup of the NHS. His statements at this
week's Labour conference are couched in terms of getting the
structure he would inherit to "work differently". The reality is
that he is proposing far-reaching change with significant risks
for service quality.
At a Guardian healthcare network fringe meeting on Tuesday
Burnham said: "The health service would not survive two
terms of [David] Cameron … the NHS would not be a national
service at the end." Such remarks are a conference ritual; I
remember listening to the then shadow health secretary,
Robin Cook, warn in 1991 that if Labour lost the election the
following year, it may be too late to save the NHS. The Tories
got back in, the NHS survived. It will this time as well.
Read the full article on the Guardian healthcare network
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Public Policy Media
Richard Vize