Lansley slammed for refusal to lead 29 June 2012 At last week's NHS Confederation conference, the health secretary Andrew Lansley was battered by the biggest hitters in the health service over his cowardice on moving and closing services. Opening the conference Mike Farrar, respected chief executive of the confederation, almost begged for some political leadership on the issue of "service reconfigurations". He warned the NHS was endangering lives by "almost waiting for services to fail". The announcement just five days later of the financial troubles of the South London Healthcare Trust lends weight to his contention. He argued the NHS needs to take the difficult decisions to move some care – notably for patients with dementia – out of hospitals into the community, while specialist services need to be concentrated in fewer centres to improve outcomes. In other words, avoid losing lives. Read the full article on the Guardian healthcare network __________________________________________________ Councils’ biggest storm is still to come 22 June 2012 Councillors and managers gathering in Birmingham next week for the Local Government Association (LGA) annual conference have survived the first months of the financial storm in surprisingly good shape. But they are now preparing for far worse to come. The speculation is that the next comprehensive spending review could result in a further cut as high as 20% on top of the existing 30%. Communities secretary Eric Pickles has got away for far too long with perpetuating the myth that sorting out the back office and sharing chief executives is going to deliver the required savings. SRead the full article on the Guardian local government network __________________________________________________ How will managers lead the new NHS? 20 June 2012 As the reforms enshrined in the Health and Social Care Act take shape, no one knows where the power lies, who will lead the system or whether the weakest trusts will be left to the predations of the market. From next April responsibility for buying around £60bn of healthcare services, mainly from hospitals, will move from primary care trusts to local clinical commissioning groups (CCGs) led by GPs. Nationally, the new NHS Commissioning Board will set standards, hold the commissioning groups to account and implement policy priorities laid down by the government. As money for providers gets tighter, services will need to be "reconfigured" to produce savings, such as by moving specialist services to regional centres. But will changes be planned, or will they be triggered by a weak trust getting into financial difficulties? Read the full article on the Guardian healthcare network __________________________________________________ Leaders need to bring order to chaos 14 June 2012 Next week managers meeting in Manchester for the annual NHS Confederation conference will be looking to the health service leadership to bring order to the chaos of the reforms. Key signals on the way ahead will come from four major players - two new, one unassailable and one mortally wounded. Health secretary Andrew Lansley will be taking to the stage on the eve of doctors taking industrial action over pension reform. This will give him an easy way to distract attention from more pressing long-term concerns. If he is moved or dropped in the expected reshuffle this may be Lansley's last major speech to the health world. Read the full article on the Guardian healthcare network __________________________________________________ Pickles’ puerile high street revival plan 8 June 2012 This week saw the latest instalment of the government's witless approach to regenerating the country's high streets. Following the platitude-strewn high street review by Mary Portas, who likes to be known as "the queen of shops", we now have what the Department for Communities and Local Government is billing as "Eric Pickles' local shop parades plan". His plan: "Parades to be proud of: strategies to support local shops" is patronising drivel. Only a council unaware that it actually has shops could find it useful. It reveals, for example, that it is a good idea for markets to have a website, clinics can help pharmacies, and you should do something interesting with empty shops. Read the full article on the Guardian local government network __________________________________________________ Time for shift away from NHS managers 31 May 2012 Moves to shift power from managers to clinicians will be all but worthless unless clinicians in turn cede power to patients. And patients are the managers' best hope for securing better and cheaper services. It is an extraordinary British tradition that our brightest schoolchildren yearn to spend years training for modestly remunerated jobs in a nationalised industry – as doctors in the NHS. The realisation that the long term viability of the health service requires heroic improvements in quality and productivity is compelling managers to liberate the immense talents of these, and all their other, clinical staff. Read the full article on the Guardian healthcare network __________________________________________________ Hard-won progress on integration 31 May 2012 The same patient was admitted to an emergency department 19 times in six months with hypoglycaemia, but no one ever told his diabetes consultant in the same hospital. The North West London integrated care pilot is working to ensure that never happens again. The pilot was launched in 2011 to meet the needs of people with diabetes and those aged over 75. It brings together primary care, community services, acute care, social care, and mental health. Read the full article at the British Medical Journal The article was discussed for several minutes at the Health Select Committee hearing on 26 June 2012 on integrated care, beginning at 12.25. __________________________________________________ Councils offer a new education future 25 May 2012 In January this column highlighted the urgency of local government redefining its role in light of the government's school reforms. Over the past two years perceptions of the academy movement have shifted. When, under Labour, about 200 of the poorest performing schools were given academy status, it was seen as freeing them from local government control. Now the number is climbing past 1,600, it looks like a school system that is simultaneously fragmenting and being centralised under the increasingly interventionist education secretary Michael Gove. Read the full article on the Guardian local government network __________________________________________________ Services collapse exposes reform cracks 17 May 2012 Just weeks after the health reforms passed into law, serious cracks have emerged in the new system that could derail both the quality and financial stability of NHS services. The NHS Commissioning Board has revealed that as a result of its "Checkpoint 2" tests for the viability of the plans for 25 regional commissioning support services, two have had to be abandoned: West Mercia and Peninsula (Devon and Cornwall). A further nine require "more rapid management" to stop them from failing. The support services are often wrongly described as providing "administrative functions" for clinical commissioning groups. Read the full article on the Guardian healthcare network __________________________________________________ The unforgivable failure on social care 11 May 2012 The government's refusal to introduce a comprehensive social care reform bill is an unforgiveable failure of leadership. Ministers spout slogans about joined up policymaking while the most critical issue facing us after the economy is trapped between a discredited health secretary and an intransigent Treasury. And it affects the whole of local government. The Queen's speech included provision for a children and families bill while leaving some of the most vulnerable family members in dire need. The government had an opportunity to act, and has baulked. Read the full article on the Guardian local government network __________________________________________________ Can NHS escape centralised control? 3 May 2012 More than most organisations, the culture of the NHS starts at the top. As implementation of the reforms gathers pace, can the old leadership deliver a new culture that liberates managers and clinicians? In the health white paper in 2010 the government promised to "free staff from excessive bureaucracy and top-down control". As the structure and processes of the new system have started to take shape, it has become clear that freedom is no longer on offer. The best the new clinical commissioning groups (CCGs) can hope for is extended parole. Read the full article on the Guardian healthcare network __________________________________________________ Can the markets ever work for councils? 27 April 2012 Despite the apparent collapse of Suffolk's "commissioning council" plans (I say apparent because they are quietly implementing many of their ideas but without frightening the residents with any more talk of "burning platforms"), local authorities are still grappling with how to make commissioning and markets work for them as budgets fall. Many of the issues were aired at a seminar hosted by the Institute for Government last week. Just as being force fed is unlikely to increase one's appreciation of food, local government has never quite recovered from being forced to outsource what were then known as blue-collar services in the 1980s. Read the full article on the Guardian local government network __________________________________________________ Adult and child care heading for trouble 13 April 2012 The government is getting into difficulties on both adult and children's social care. In each case there are three problems: funding, reform and ministerial rhetoric. In adult care, the government is in denial about the consequences of falling funding and rising demand. Care services minister Paul Burstow appears capable of standing next to a building billowing smoke and flames and saying there is no fire. In recent evidence to the health select committee, he claimed the funding settlement plus savings from redesigning services meant everything was fine. Any cuts were local authorities' fault, apparently. The Association of Directors of Adult Social Services has added to the confusion by claiming that there is a funding gap of up to £25bn. This was based on scaling up a study of need in Birmingham to cover the entire country. Councils can't expect ministers to play straight with the funding facts if their own advocates make such extravagant claims on such thin evidence. Read the full article on the Guardian local government network __________________________________________________