Richard Vize Public Policy Media Ltd
LATEST ARTICLES
CV
Council role in solving energy crisis 22 February 2013 As the energy regulator Ofgem warns that the UK is going to be increasingly dependent on expensive imports of gas to keep its lights on, what is local government's role in managing and meeting our energy needs? Local government's involvement in the energy industry, is huge. From facilitating the building of power stations and authorising the storage of nuclear waste to promoting energy efficiency in factories and homes, councils participate in almost every step along the supply chain. Ever since the 1950s, when the local planning committee took just 45 minutes to approve the building of Dounreay, the first nuclear power station primarily used for civilian power, councils have been closely involved in the development of the nuclear industry. The prospect of business rates from a new nuclear power station being built at Hinckley Point is about the only good financial news in prospect for imploding West Somerset district council. Read the full article on the Guardian local government network ____________________________________________________________________ The price for not winning over public 21 February 2013 North London's Whittington hospital provides the latest excruciating example of how not manage service reorganisations. By mishandling the communication of plans to replace wards with community facilities it has a rebellion on its hands. What hospital managers regarded as an "estates strategy" has now been described in the Camden New Journal, which broke the story, as "a dramatic plan to dismantle the Highgate hospital". It said there had been a "hush- hush decision by the board to sell off £17m worth of public buildings … and close three wards on the main site, halve the total number of patient beds to 177 and axe 570 jobs, including around 200 nurses". It's not hush hush now. After the plans emerged, around 500 people turned out last week to give managers a thrashing at a public meeting in the local Methodist hall, led by the Defend the Whittington Hospital Coalition. A mass lobby of a board meeting is imminent and a demonstration is taking place in Islington next month. And in its apparent determination to alienate as many people as possible, the trust has had to make a "grovelling apology" to local MP Lynne Featherstone for misrepresenting her position. Read the full article on the Guardian healthcare network ____________________________________________________________________ Francis Inquiry causes new problem 13 February 2013 The recommendations of the Francis Inquiry cannot simply be implemented. It is a complicated set of proposals that will create new difficulties and challenges for the medical profession. Doctors need to lead the debate on what happens next. Robert Francis’s lawyerly circumlocution, filling almost 1,800 pages, guarantees that virtually nobody will read the whole report. Are public inquiry chairs paid by the kilogram? But at its core is the powerful concept of professionals adhering to “fundamental standards” to be enshrined in the NHS Constitution and health service regulations and policed by the Care Quality Commission. Crucially, Francis calls for “zero tolerance” of breaches. As Francis makes clear in his interview with the BMJ, this means wards and operating theatres should be closed if they cannot meet the standards. Assuming the government accepts this recommendation, the Department of Health will be consulting on it extensively. It is vital that the medical and nursing professions do not just participate in this discussion, but are publicly seen to take the lead in identifying what these standards should be and how they should be implemented. This is, of course, complex territory for the medical profession; on paper at least the Francis report marks the beginning of a process to put more power back in the hands of clinicians. More certain is that it gives them more responsibility and risk. Read the full article at the British Medical Journal ____________________________________________________________________ Cameron is undermining radical change 8 February 2013 The prime minister, David Cameron, is personally undermining councils' attempts to make the radical changes required to survive years of austerity. At the Guardian Public Services Summit on Wednesday, experts lined up to stress that the public sector will not be able to cope with the years of austerity stretching out before us by simply "slimming the staff and dimming the lights". As Sir Bob Kerslake, head of the home civil service, emphasised, transformation rather than tinkering is key. Sharon White, director-general for public spending at the Treasury, stressed how far the public was from understanding the profound implications of the gap opening up between where the economy would have been without the recession and where it is heading. The Office for Budget Responsibility's own "graph of doom" shows this gap will be approaching 20% towards the end of the decade. Again and again, speakers and delegates stressed the importance of developing a shared understanding between decision-makers and the public of what this all means and the resulting need to radically reform services and reduce or change demand. Read the full article on the Guardian local government network ____________________________________________________________________ Who will lead NHS culture change? 7 February 2013 So who is going to change the culture in the NHS? Despite the questionable wisdom of making 290 recommendations, some of which seem far too detailed for a public inquiry, Robert Francis's report into the Mid Staffordshire hospital scandal provides solid foundations for changes in the management and clinical practice of the health service – but someone has to make the first move. The coincidence of the publication of the inquiry's final report with the imminent change to the new NHS structure does at least provide an opportunity for a new culture to take root in the new organisations. But it will take more than that to change bad habits. Some years ago I was talking to a highly respected manager about the experience of discussing problems hitting the four-hour A&E waiting target with his strategic health authority chief executive, David Nicholson. "I didn't need to be told that my career depended on it," he said, "I felt it with every bone in my body." The Francis inquiry also reminds me of a chief executive who tried to push back on the four-hour target, on the grounds that their hospital had more pressing priorities. They were sacked. If the inquiry is to mean anything, then those types of conversations have to stop. Senior managers in the outposts of the NHS Commissioning Board need to know they cannot pressure managers to distort clinical priorities in that manner, and the NHS leadership must not push them to do so. Read the full article on the Guardian healthcare network ____________________________________________________________________ Burnham plans huge NHS overhaul 4 February 2013 With little media attention, shadow health secretary Andy Burnham has proposed scrapping clinical commissioning as part of a new round of NHS upheaval if Labour is returned to office. In a speech at the King’s Fund recently, Burnham tried to portray his ideas as a mere reshuffling of the structures that will be in place this April. Just like Andrew Lansley in opposition, Burnham said “our fragile NHS has no capacity for further top-down reorganisation… I know that any changes must be delivered through the organisations and structures we inherit.” But he goes on to propose profound changes in the way the NHS is structured. He is developing a plan which will require change at least as great as that needed for the coalition government’s own reform plans. Read the full article at the British Medical Journal ____________________________________________________________________ Flaws in Labour’s council plan for NHS 25 January 2013 If there is one lesson that can be drawn from Andrew Lansley's health reforms, it is that anyone proposing a major shakeup of the NHS should be required to provide compelling and overwhelming evidence that it is the right thing to do. This is the lens through which the idea of shadow health secretary, Andy Burnham, to hand about £63bn of health service commissioning to local government should be judged. In a speech to the King's Fund on Thursday outlining his proposals Burnham said: "I want to be clear: nothing I have said today requires a top-down structural reorganisation." Don't be fooled; this would shake the ground of healthcare barely five years after the present reforms, when they would just be starting to bed down. He is suggesting that local authorities take control of the funding for general hospital, community and mental health services. They would be free to spend it how they like; it would not be ringfenced. Health and wellbeing boards would become the local top dog, while the GP-led clinical commissioning groups (CCGs) would be scrapped and replaced with GP advisory bodies (although he still calls them CCGs). NHS trusts would be the "preferred provider" for hospital, community and social care services. Read the full article on the Guardian local government network ____________________________________________________________________ Have NHS managers got the right skills? 24 January 2013 Managers in both acute trusts and clinical commissioning groups have been scrutinised by the NHS leadership in the last few days and found wanting. The NHS Commissioning Board is tightening its grip on clinical commissioning groups. On Wednesday, the announcement of the second wave of CCGs to be authorised revealed that three of the 67 – Herts Valleys, Medway and Nene in Northamptonshire – have been formally warned they could have members imposed on their board if they do not improve their performance. On the CCG authorisation Richter scale these are ranked as "level 4" conditions. Levels 5, 6, and 7 consist respectively of firing the accountable officer, stripping the organisation of specific functions and closing the CCG down. Those at highest risk of suffering these sanctions are still going through the authorisation mill. Read the full article on the Guardian healthcare network ____________________________________________________________________ How can LGA counter Pickles’ attacks? 11 January 2013 What is striking about the reaction to the funding settlement announced just before Christmas is that while councils can cope with the prospect of further cuts, what angers them is the way they are presented. Communities secretary Eric Pickles no doubt enjoyed baiting local government by publishing his ludicrous 50 Ways to Save booklet just before the figures were released. Predictably, the booklet received a less than enthusiastic response from councils, but more surprising was how much it riled members of his own party. After the Conservatives were defeated in the 1997 general election, seething resentment from among its local government ranks was laid bare in the post-mortems about where the party had lost its way. A motivated and loyal local government base is a prerequisite for success in what the Americans call the ground war of elections. Pickles' derisive treatment of his own party members may not seem quite so funny in 2015. Read the full article on the Guardian local government network ____________________________________________________________________ What awaits health managers in 2013? 10 January 2013 As the NHS stumbles towards the formal start of the new, reorganised structure in April, some of the big issues the service faces seem barely changed from a year ago. We are still waiting for the report by Robert Francis QC into the Mid Staffordshire scandal, many managers still don't know if they will have a job in the new system, the Care Quality Commission is still in difficulty, and the overwhelming majority of clinical commissioning groups still have a long way to go before they are truly ready. The NHS Commissioning Board's most pressing priority is to get the remaining 177 clinical commissioning groups through the authorisation process. Only 34 have completed it. Among those in the pipeline will be some barely fit to begin work. Neighbouring groups might have to take on the work of the stragglers. While those in difficulty will doubtless attract a great deal of attention, it is in no one's interests for their weaknesses to undermine confidence in the whole system. Read the full article on the Guardian healthcare network
January to February 2013
Richard Vize Public Policy Media Ltd
LATEST ARTICLES
CV
Council role in solving energy crisis 22 February 2013 As the energy regulator Ofgem warns that the UK is going to be increasingly dependent on expensive imports of gas to keep its lights on, what is local government's role in managing and meeting our energy needs? Local government's involvement in the energy industry, is huge. From facilitating the building of power stations and authorising the storage of nuclear waste to promoting energy efficiency in factories and homes, councils participate in almost every step along the supply chain. Ever since the 1950s, when the local planning committee took just 45 minutes to approve the building of Dounreay, the first nuclear power station primarily used for civilian power, councils have been closely involved in the development of the nuclear industry. The prospect of business rates from a new nuclear power station being built at Hinckley Point is about the only good financial news in prospect for imploding West Somerset district council. Read the full article on the Guardian local government network ____________________________________________________________________ The price for not winning over public 21 February 2013 North London's Whittington hospital provides the latest excruciating example of how not manage service reorganisations. By mishandling the communication of plans to replace wards with community facilities it has a rebellion on its hands. What hospital managers regarded as an "estates strategy" has now been described in the Camden New Journal, which broke the story, as "a dramatic plan to dismantle the Highgate hospital". It said there had been a "hush-hush decision by the board to sell off £17m worth of public buildings … and close three wards on the main site, halve the total number of patient beds to 177 and axe 570 jobs, including around 200 nurses". It's not hush hush now. After the plans emerged, around 500 people turned out last week to give managers a thrashing at a public meeting in the local Methodist hall, led by the Defend the Whittington Hospital Coalition. A mass lobby of a board meeting is imminent and a demonstration is taking place in Islington next month. And in its apparent determination to alienate as many people as possible, the trust has had to make a "grovelling apology" to local MP Lynne Featherstone for misrepresenting her position. Read the full article on the Guardian healthcare network ____________________________________________________________________ Francis Inquiry causes new problem 13 February 2013 The recommendations of the Francis Inquiry cannot simply be implemented. It is a complicated set of proposals that will create new difficulties and challenges for the medical profession. Doctors need to lead the debate on what happens next. Robert Francis’s lawyerly circumlocution, filling almost 1,800 pages, guarantees that virtually nobody will read the whole report. Are public inquiry chairs paid by the kilogram? But at its core is the powerful concept of professionals adhering to “fundamental standards” to be enshrined in the NHS Constitution and health service regulations and policed by the Care Quality Commission. Crucially, Francis calls for “zero tolerance” of breaches. As Francis makes clear in his interview with the BMJ, this means wards and operating theatres should be closed if they cannot meet the standards. Assuming the government accepts this recommendation, the Department of Health will be consulting on it extensively. It is vital that the medical and nursing professions do not just participate in this discussion, but are publicly seen to take the lead in identifying what these standards should be and how they should be implemented. This is, of course, complex territory for the medical profession; on paper at least the Francis report marks the beginning of a process to put more power back in the hands of clinicians. More certain is that it gives them more responsibility and risk. Read the full article at the British Medical Journal ____________________________________________________________________ Cameron is undermining radical change 8 February 2013 The prime minister, David Cameron, is personally undermining councils' attempts to make the radical changes required to survive years of austerity. At the Guardian Public Services Summit on Wednesday, experts lined up to stress that the public sector will not be able to cope with the years of austerity stretching out before us by simply "slimming the staff and dimming the lights". As Sir Bob Kerslake, head of the home civil service, emphasised, transformation rather than tinkering is key. Sharon White, director-general for public spending at the Treasury, stressed how far the public was from understanding the profound implications of the gap opening up between where the economy would have been without the recession and where it is heading. The Office for Budget Responsibility's own "graph of doom" shows this gap will be approaching 20% towards the end of the decade. Again and again, speakers and delegates stressed the importance of developing a shared understanding between decision-makers and the public of what this all means and the resulting need to radically reform services and reduce or change demand. Read the full article on the Guardian local government network ____________________________________________________________________ Who will lead NHS culture change? 7 February 2013 So who is going to change the culture in the NHS? Despite the questionable wisdom of making 290 recommendations, some of which seem far too detailed for a public inquiry, Robert Francis's report into the Mid Staffordshire hospital scandal provides solid foundations for changes in the management and clinical practice of the health service – but someone has to make the first move. The coincidence of the publication of the inquiry's final report  with the imminent change to the new NHS structure does at least provide an opportunity for a new culture to take root in the new organisations. But it will take more than that to change bad habits. Some years ago I was talking to a highly respected manager about the experience of discussing problems hitting the four- hour A&E waiting target with his strategic health authority chief executive, David Nicholson. "I didn't need to be told that my career depended on it," he said, "I felt it with every bone in my body." The Francis inquiry also reminds me of a chief executive who tried to push back on the four-hour target, on the grounds that their hospital had more pressing priorities. They were sacked. If the inquiry is to mean anything, then those types of conversations have to stop. Senior managers in the outposts of the NHS Commissioning Board need to know they cannot pressure managers to distort clinical priorities in that manner, and the NHS leadership must not push them to do so. Read the full article on the Guardian healthcare network ____________________________________________________________________ Burnham plans huge NHS overhaul 4 February 2013 With little media attention, shadow health secretary Andy Burnham has proposed scrapping clinical commissioning as part of a new round of NHS upheaval if Labour is returned to office. In a speech at the King’s Fund recently, Burnham tried to portray his ideas as a mere reshuffling of the structures that will be in place this April. Just like Andrew Lansley in opposition, Burnham said “our fragile NHS has no capacity for further top-down reorganisation… I know that any changes must be delivered through the organisations and structures we inherit.” But he goes on to propose profound changes in the way the NHS is structured. He is developing a plan which will require change at least as great as that needed for the coalition government’s own reform plans. Read the full article at the British Medical Journal ____________________________________________________________________ Flaws in Labour’s council plan for NHS 25 January 2013 If there is one lesson that can be drawn from Andrew Lansley's health reforms, it is that anyone proposing a major shakeup of the NHS should be required to provide compelling and overwhelming evidence that it is the right thing to do. This is the lens through which the idea of shadow health secretary, Andy Burnham, to hand about £63bn of health service commissioning to local government should be judged. In a speech to the King's Fund on Thursday outlining his proposals Burnham said: "I want to be clear: nothing I have said today requires a top-down structural reorganisation." Don't be fooled; this would shake the ground of healthcare barely five years after the present reforms, when they would just be starting to bed down. He is suggesting that local authorities take control of the funding for general hospital, community and mental health services. They would be free to spend it how they like; it would not be ringfenced. Health and wellbeing boards would become the local top dog, while the GP-led clinical commissioning groups (CCGs) would be scrapped and replaced with GP advisory bodies (although he still calls them CCGs). NHS trusts would be the "preferred provider" for hospital, community and social care services. Read the full article on the Guardian local government network ____________________________________________________________________ Have NHS managers got the right skills? 24 January 2013 Managers in both acute trusts and clinical commissioning groups have been scrutinised by the NHS leadership in the last few days and found wanting. The NHS Commissioning Board is tightening its grip on clinical commissioning groups. On Wednesday, the announcement of the second wave of CCGs to be authorised revealed that three of the 67 – Herts Valleys, Medway and Nene in Northamptonshire – have been formally warned they could have members imposed on their board if they do not improve their performance. On the CCG authorisation Richter scale these are ranked as "level 4" conditions. Levels 5, 6, and 7 consist respectively of firing the accountable officer, stripping the organisation of specific functions and closing the CCG down. Those at highest risk of suffering these sanctions are still going through the authorisation mill. Read the full article on the Guardian healthcare network ____________________________________________________________________ How can LGA counter Pickles’ attacks? 11 January 2013 What is striking about the reaction to the funding settlement announced just before Christmas is that while councils can cope with the prospect of further cuts, what angers them is the way they are presented. Communities secretary Eric Pickles no doubt enjoyed baiting local government by publishing his ludicrous 50 Ways to Save booklet just before the figures were released. Predictably, the booklet received a less than enthusiastic response from councils, but more surprising was how much it riled members of his own party. After the Conservatives were defeated in the 1997 general election, seething resentment from among its local government ranks was laid bare in the post-mortems about where the party had lost its way. A motivated and loyal local government base is a prerequisite for success in what the Americans call the ground war of elections. Pickles' derisive treatment of his own party members may not seem quite so funny in 2015. Read the full article on the Guardian local government network ____________________________________________________________________ What awaits health managers in 2013? 10 January 2013 As the NHS stumbles towards the formal start of the new, reorganised structure in April, some of the big issues the service faces seem barely changed from a year ago. We are still waiting for the report by Robert Francis QC into the Mid Staffordshire scandal, many managers still don't know if they will have a job in the new system, the Care Quality Commission is still in difficulty, and the overwhelming majority of clinical commissioning groups still have a long way to go before they are truly ready. The NHS Commissioning Board's most pressing priority is to get the remaining 177 clinical commissioning groups through the authorisation process. Only 34 have completed it. Among those in the pipeline will be some barely fit to begin work. Neighbouring groups might have to take on the work of the stragglers. While those in difficulty will doubtless attract a great deal of attention, it is in no one's interests for their weaknesses to undermine confidence in the whole system. Read the full article on the Guardian healthcare network