LATEST ARTICLES
Regulator beatings don’t secure
change
11 December 2014
There are two narratives in the NHS inspired by the central
bodies; one is a story of opportunities and possibilities, the
other is finding someone to blame. While the regulatory
beatings are continuing, there are signs the positive approach
is gaining ground.
In recent days the Care Quality Commission has been choking
on its own bile. First it had to admit that it had wrongly
categorised 60 GP practices as high risk in ratings it had
published for surgeries across England, after a BBC
investigation uncovered flaws in its methodology and a failure
to test the data properly.
Then on Tuesday the CQC agreed to pay £570,000 in an out-of-
court settlement for a libel action brought by its former
deputy chief executive, Jill Finney. The dispute arose from the
investigation by consultants Grant Thornton into the CQC’s
flawed oversight of University Hospitals of Morecambe Bay
NHS foundation trust.
Read the full article on the Guardian Healthcare Network
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Kerslake reveals the rot in
Birmingham
10 December 2014
Birmingham city council is right to reject a government-
inspired plan to oversee it with an improvement panel – but
now members have to demonstrate they are able to change,
and rapidly.
On 9 December Sir Bob Kerslake, permanent secretary at the
Department for Communities and Local Government,
published the results of his five-month inquiry into how
Birmingham should address its dysfunctional politics and
culture. His key recommendation is that the community
secretary should appoint an independent improvement panel
to provide “robust challenge and support” as the city tries to
find a way out of difficulties largely of its own making.
In the report, which was a consequence of the Trojan Horse
letter about extremism in Birmingham schools, Kerslake
highlights deep-seated problems such as a low-skilled
workforce, an arrogant attitude towards partnerships, a
multiplicity of plans and strategies that are not followed
through and the absence of a clearly articulated vision for the
city.
Read the full article on the Guardian Public Leaders Network
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What will end NHS resistance to
change?
27 November 2014
Sir Stephen Bubb’s report exposing the failure of the NHS to
reform the care of people with learning disabilities highlights
the health service’s extraordinary ability to resist pressures to
change.
While clinical and technological innovations are commonplace,
the Bubb report exemplifies the way the NHS often seems
impervious to system reform.
After Panorama broadcast videos revealing the cruelty of staff
at Winterbourne View, the government pledged to move all
people with learning disabilities or autism inappropriately
placed in institutions into community care. Three years later,
more people are institutionalised than ever.
Everyone agreed what needed to be done. There were plenty
of reports outlining what good services look like and how to
commission them. A concordat was signed by more than 50
organisations – from the Department of Health to the NHS
Confederation to social care bodies.
Read the full article on the Guardian Healthcare Network
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Faults at the heart of Better Care
Fund
13 November 2014
The National Audit Office’s (NAO) forensic dissection of the
Better Care Fund fiasco is a harsh lesson in the dangers of
ministerial interference in health and care systems under
stress.
Its report Planning for the Better Care Fund – published this
week – exposes how the government mishandled the entire
project. The fund was the coalition’s gambit in the battle with
Labour over who would integrate the NHS and social care.
Launched as a flagship policy in the 2013 Autumn Statement,
it was a triumph of presentation over strategic thinking – big,
bold, long on rhetoric, short on delivery detail and recycling
old money as extra funding.
It soon hit trouble. NHS England and the Local Government
Association (LGA) published guidance on how it would work
that December, and all local areas submitted bids by April on
how they would spend their cut in 2015-16.
Read the full article on the Guardian Healthcare Network
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Devolution offers rare reform
chance
31 October 2014
A rare opportunity has opened up in the 40-year struggle to
devolve more power to England’s towns and cities and finally
make local government finance self-sufficient.
As Labour leader Ed Miliband announces a sweeping set of
policies to transfer more power to local regions, now is the
time to seize the chance created by the devolution debate and
the need to get public services through another five years of
cuts.
The Independent Commission on Local Government Finance’s
interim report, Public Money, Local Choice, which I helped
draft, wants to secure radical change to the relationship
between central and local government - nothing less than
making local government financially self-sufficient.
The commission, chaired by former senior public servant
Darra Singh, was set up in June 2013 by the Local Government
Association and public sector accountancy body CIPFA to
tackle the urgent issue of how to reform local government
funding.
Read the full article on the Guardian Public Leaders Network
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Pressure on to develop new care
models
30 October 2014
Among the scores of commitments to reform which came
tumbling out of NHS England’s Five Year Forward View last
week, a picture emerges of how the national bodies are going
to leverage reforms among both the high-performers and the
strugglers.
At the struggling end, the national bodies have promised to
take a joined-up approach to addressing weaknesses across
whole health economies rather than separately targeting
failing organisations.
With 18 clinical commissioning groups expecting to end the
financial year in deficit, and around another 30 perilously
close, there will not be a shortage of candidates to test this
approach.
The frequent inability of NHS England, the Care Quality
Commission, NHS Trust Development Authority and Monitor
to coordinate their work around failing organisations and
systems is a routine source of complaint among providers and
clinical commissioners.
Read the full article on the Guardian Healthcare Network
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Can Darzi plan improve London’s
health?
16 October 2014
London’s healthcare consumes around a fifth of the NHS
budget for England. On Wednesday, at the behest of mayor
Boris Johnson, eminent surgeon Lord Darzi launched his
second plan in seven years for wholesale reform of the city’s
health systems.
London’s NHS is a patchwork of brilliance and failure; loss-
making hospitals with seemingly intractable care quality
problems sit alongside trusts providing some of the finest
specialist care in the world. Networks of GPs achieving
extraordinary results in some of the poorest communities in
Britain work down the road from practices with a single GP
that should not be part of 21st-century healthcare.
Seven years ago Darzi published his Framework for Action,
commissioned by NHS London. Then, his plan for moving
substantial care from hospitals to GP-led polyclinics was
largely thwarted by GP opposition, but his call for trauma,
hyper acute stroke and heart attack services to be centralised
in specialist units achieved results that attracted international
attention.
Read the full article on the Guardian Healthcare Network
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Tory and Labour policies don’t
add up
2 October 2014
The NHS will be at the centre of the general election
campaign. During the party conferences Labour and the Tories
each used the same brutal, disingenuous techniques to win
the argument – low blows aimed at inducing fear about their
opponent’s record followed by promises of more staff and
better services built on a financial mirage.
There was nothing in Labour leader Ed Miliband’s speech –
even the version including the bits he forgot – that came close
to being a coherent plan for running effective public services
while meeting his party’s promise to eliminate the deficit.
There barely a hint of the difficult choices to come.
The shadow health secretary, Andy Burnham, also swerved
round the growing financial crisis to concentrate on his vision
of bringing health and social care into a single service. His big
idea is for hospital trusts to evolve into integrated care
organisations, meeting virtually all physical, mental and social
care needs.
Read the full article on the Guardian Healthcare Network
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Dogmatic bullies suppress local
debate
2 October 2014
As Scotland attempts to come to terms with the result of its
independence referendum, it’s trying to find where robust
political debate morphs into bullying. In her now-famous
tweet in support on the no vote, novelist J K Rowling said
“whatever happens, I hope we’re all friends by Saturday”.
It’s a sentiment that might be echoed in local authorities
around the country, where there is no shortage of evidence
that bust-ups often supersede listening – even to your own
side. This was recently laid bare in a peer review of Thanet
district council.
“Barracking, bullying and talking over others are behaviours
which … damage the council’s reputation. There are things
that all councillors can and should do, including listening
respectfully to the contributions of others [and] avoiding the
use of personal insults.”
Robust political debate is the heartbeat of local government,
but too often it mutates into the dogmatic application of
power.
Read the full article on the Guardian Public Leaders Network
Public Policy Media
Richard Vize