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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________