LATEST ARTICLES
Tide turns on privatising public services
29 March 2019
The rebellion against privatisation is growing, with the tide moving towards
greater public control of key services.
The pushback can be seen everywhere. In an excoriating assessment of a
flagship government policy, the chief inspector of probation, Dame Glenys
Stacey, has used her final annual report to condemn the part privatisation of
the probation service for a “deplorable diminution of the probation
profession”.
The fatal mistake was to try to reduce what is a complex social service to a
series of contractually defined transactions. Stacey makes clear that the
government’s recovery plan – to terminate contracts early and retender – is
largely a waste of time, because it will not fix the underlying problem that
running probation commercially won’t work.
NHS England has abandoned a bizarre scheme to force cancer patients at
the renowned Churchill hospital in Oxford to be loaded into an ambulance
and driven four miles down the road to use private sector scanners rather
than be scanned on site by NHS staff.
The retreat came as Jeremy Corbyn joined the backlash and Labour revealed
plans to ban private companies from providing services that deal with
vulnerable people.
Read the full article at Guardian Society
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Perpetual failures of financial incentives
14 March 2019
The King’s Fund wants to kill off the long-held belief in government and the
NHS leadership in England that it is possible to devise a system of payments,
incentives and contracts which will take us to the nirvana of a perpetually
self-improving health service.
After 30 years of failure the NHS is embarking on yet another attempt to
devise the perfect payment regime. In its report Payments and contracting
for integrated care, with the punchier subtitle “the false promise of the self-
improving health system”, the King’s Fund highlights the absurdity of
clinging to this shibboleth despite decades of evidence that it won’t work.
The NHS has set prices for around 3000 services, ranging from £63 for the
simplest A&E attendance to £40,550 for complex cranial operations.
Alongside this clinical shopping list is a Heath Robinson construction of
uplifts, carve-outs, caps, bundles, blocks, baselines, risk transfers, gain
sharing, loss sharing, penalties and incentives designed to drive behaviours
around everything from adopting new technologies to how a hospital is
cleaned.
This system fails to achieve its objectives and inhibits clinicians from
improving care quality. It encourages treatment in hospitals rather than
prevention in the community and, as the report says, there is scant evidence
that incentive schemes such as Commissioning for Quality and Innovation
(CQUIN) have delivered substantial improvements in quality or efficiency.
Read the full article at the BMJ
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Children live in a hostile environment
1 March 2019
Children in England are facing their own hostile environment, with
government policy undermining their right to a fair start in life and support
for families systematically dismantled since 2010.
First 1,000 days of life, published this week by the Commons health and
social care committee, exposes the extent of the damage – and the impact it
has had.
The MPs’ report lays bare the desperate need for coordinated support for
infants and their families. Under New Labour, resources were poured in to
supporting children’s early years. Benefits were increased, children’s
services were expanded, child poverty was targeted, the Healthy Child
Programme was introduced and Sure Start centres were established across
the country.
But since the economic crash in 2008 and change of government in 2010,
public spending on children has fallen and child poverty has increased, as
evidence from the children’s commissioner for England and the Institute for
Fiscal Studies shows. According to the Sutton Trust, somewhere in the
region of 1,000 Sure Start centres have closed – more than a quarter of the
total. The Institute for Health Visiting told MPs that 65% of families are not
formally seeing a health visitor after their baby is aged eight weeks.
Read the full article at Guardian Society
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NHS and council tensions are on the rise
15 February 2019
Who should run local health and care services, especially public health
services, is becoming an increasingly tense battleground between the NHS
and local government, with serious potential consequences.
The NHS long-term plan, unveiled in January, aims to deliver the “triple
integration” of primary and hospital care, physical and mental health
services and health with social care. From councils’ point of view, this is a
unique opportunity to fix one of the big flaws in the way the NHS was set up
in 1948, with a centralised service telling local services what to do, rather
than focusing on the needs of local communities.
With NHS community and mental health services – especially mental health
care for children and adolescents – set to be the big winners in the scramble
for funding for at least the next five years, local NHS services and councils
have a chance to focus on tackling the root causes of physical and mental
illness in their area.
The NHS plan wisely avoids setting out precisely how this local collaboration
should happen, putting the onus on local leaders to find ways to work
together. Some are struggling.
Read the full article at Guardian Society
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The health impact of a bankrupt council
5 February 2019
As the NHS in England begins implementing its plan for spending its
additional £20bn over the next 10 years, a growing number of local
authorities facing financial crisis are slashing adult social care budgets.
The long term impact on health services will be profound, affecting
everything from hospital discharge to falls prevention and rehabilitation.
According to the Association of Directors of Adult Social Services, councils in
England are taking out £700m from their adult spending this financial year,
4.7% of that budget.
East Sussex County Council is planning to strip its services back to a “core
offer,” which includes reducing services for vulnerable children and adults.
Worcestershire County Council is looking to shed around 200 staff—which
will have a serious impact on child and adult social care which accounts for
almost 70% of its budget. Other councils facing serious financial pressures
include Cornwall, Lincolnshire, Somerset, Surrey, and Torbay.
Northamptonshire County Council—whose problems have been
exacerbated by mismanagement—is in the deepest trouble. Last autumn, it
adopted a financial stabilisation plan: targets include saving £700,000 by
reducing long term care placements from hospital and £1.8m from “new
ways of delivering care and independence.”
Read the full article at the BMJ
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Austerity-battered cities need champion
1 February 2019
This week’s report spelling out the calamitous impact of austerity on our
major cities shows that much of the current debate over public policy is
looking in the wrong place for answers.
Thanks to Northamptonshire county council blowing up its own finances,
Surrey using its muscle within the Conservative party to highlight the
damage being done by cuts, and areas such as Somerset facing serious
difficulties, an impression has been created that English shires are suffering
the most pain under austerity.
Meanwhile, political debate on which parts of England need the most
support has focused on left-behind towns such as Hartlepool, Grimsby and
Barnsley, which have relatively low educational attainment and registered
their anger at the lack of opportunity by voting strongly to leave the EU.
But the Centre for Cities’ analysis, and its fascinating study published last
year on which areas voted for Brexit and why, rams home the point that
cities as well as towns need support in building their economic firepower.
Cities are the unrivalled engines of the economy, but have been clobbered
the hardest by austerity.
Read the full article at Guardian Society
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Patients and staff hold key to NHS Plan
11 January 2019
The newly-unveiled NHS long-term plan reveals an extraordinary breadth of
ambition for improving healthcare over the coming decade. While it
includes exciting developments in cutting-edge technology, such as gene
therapy and artificial intelligence, the greatest improvements in care and
outcomes will come not from scientific breakthroughs but from people: by
harnessing the power and talents of patients and NHS staff.
To stand a chance of the plan succeeding, the health service needs to
ensure clinicians have the power and responsibility to make change happen
and do far more to exploit the largely untapped resource of patients
themselves.
One of the plan’s key goals is to reduce unjustified variations in
performance, including significant differences in stillbirth and newborn
baby death rates. This can succeed only if frontline staff are gien the skills,
resources and encouragement to improve quality. Clinicians have to believe
they are leading this locally, rather than simply being a cog in a national
blueprint. That needs to be central to the workforce strategy, the plan for
tackling thousands of NHS vacancies, when it is finally published.
Read the full article at Guardian Society
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Public Policy Media
Richard Vize
January to March 2019