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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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 ____________________________________________________________________ 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