What if the media come for you? 27 June 2013 So what will you do if you are the next NHS organisation to be engulfed in a crisis? The current febrile run of accusation and rebuttal around the failure of Morecambe Bay's maternity service and its oversight is by no means a unique example of how the public, politicians and the media react when the health service gets it wrong. There is a strong punitive element in the reaction to a crisis – a requirement to identify and punish individuals deemed to be at fault – and it is extraordinarily difficult for managers to explain the context in which they are working or the pressures they are under. Neither is a mistake or poor judgment mitigated by evidence of prior success or good service. It is what you got wrong that will count. Read the full article on the Guardian healthcare network ____________________________________________________________________ The unsparing truth about death 21 June 2013 Local government has endured many league tables over the years, revealing performance on everything from litter to benefit payments. Now it has a league table of death. Public Health England's new Longer Lives website paints in vivid red the toll of premature mortality – before 75 years – council by council. It is, of course, dominated by northern authorities, carving a C-shaped mark of death from Redcar and Cleveland, westwards through councils such as Stockton- on-Tees, Darlington and County Durham, across to Cumbria, then south through Lancashire and eastwards back across the country through councils such as Barnsley, Wakefield and Calderdale, with North East Lincolnshire the final stop on the Grim Reaper's tour. Read the full article on the Guardian local government network ____________________________________________________________________ Community budgets grind slowly on 14 June 2013 Even by the lamentable standards of Whitehall pilots and initiatives on local government, the community budget programme is frustrating in its sloth and lack of ambition. But there is hope. The four pilots are not actually intended to make it work - they are supposed to be proving the concept. It is now proved, so let's get moving. As Local Government Association leader Sir Merrick Cockell told a communities and local government select committee hearing on the budgets: "Now is the time to move from an acceptance that it is validated to delivery; there is no reason to hold back." The LGA evidence to the committee, unintentionally mimicking the programme itself, at times got bogged down in Whitehall jargon such as "meshing" (which I think means getting things to work together) and "rigidities" (which probably means "some civil servants are being wilfully unhelpful but I'm too polite to say so"). Read the full article on the Guardian local government network ____________________________________________________________________ Picking up the pieces of surgery review 13 June 2013 The Independent Reconfiguration Panel's demolition of proposals for reconfiguring children's heart services has set the benchmark for all future service reviews. The panel told the health secretary, Jeremy Hunt, that the review of children's heart services had failed in its objective of recommending a safe, sustainable and accessible way forward. While it had no criticism of the underlying aim to concentrate services in fewer centres, it accused the review team of a flawed analysis of incomplete proposals that left many questions unanswered. These included issues at the centre of the debate, such as the minimum number of operations that should be carried out by surgeons and teams, and even what services would be where. It damned the review for "a paucity of basic information" about the clinical needs of patients. The panel didn't even have confidence in the financial viability of what had been proposed. Read the full article on the Guardian healthcare network ____________________________________________________________________ Nicholson: passion and centralism 10 June 2013 Sir David Nicholson’s last speech to the annual NHS Confederation conference as the leader of the service reflected all the traits of his seven years in control. His passion, commitment, and drive were undeniable, but he failed to acknowledge mistakes which had undermined patient care, gave little time to the role of local clinical commissioners, and saw centralised direction as the overriding driver of change. Early in his hour long address to the Liverpool audience, he admitted that a key reason behind his decision to quit after seven years as chief executive was that he had become the story over the Mid Staffordshire scandal. He also pointed out that within the last decade mortality rates across the NHS have halved; it must seem cruel to him to be taking the blame for one, but attracting little credit for the other. His frustration with politicians spilled out. His angry defence of GPs against widespread criticism seemed in part aimed at health secretary Jeremy Hunt, and he accused Coalition ministers of wasting the first two years in power on structural upheaval when they could have put their weight behind service changes such as fewer sites for children’s heart surgery. The “tyranny of the electoral cycle” cannot be allowed to paralyse vital reforms, he argued. Read the full article at the British Medical Journal ____________________________________________________________________ A look into local government's abyss 7 June 2013 The public accounts committee's dissection of the funding cuts to local government exposes flaws and ignorance in ministerial thinking which have been apparent to councils for many months. Take, for example, the failure of government to analyse how cuts in one service may affect demand on another. Cuts to social care are undoubtedly contributing to the current crisis in some A&E departments because social workers are unable to provide the support to allow many older people to be discharged from hospital promptly. But the government is responding by treating the symptom – the crush in A&E – rather than helping councils address one of the root causes of the problem. As a recent discussion at a Guardian local government Leaders’ Quarterly exposed, the Department for Work and Pensions took many weeks to realise that councils were going to have to deal with the consequences of welfare cuts. Modest amounts of money are being channeled into supporting some vulnerable people through the troubled families programme, but that work is likely to be more than cancelled out through the harm inflicted by debt, inadequate housing and mental illness resulting from welfare savings. Read the full article on the Guardian local government network ____________________________________________________________________ Will there be NHS cultural revolution? 5 June 2013 The NHS in England is awash with promises of change. In the wake of health reforms and the Francis inquiry into the Mid- Staffordshire scandal – which examined the failure of the system to identify and act upon poor standards of care that may have led to hundreds of deaths between 2005 and 2009 – staff have been bombarded with vows of clinical leadership, an end to bullying and a renewed focus on patients. But will NHS managers really take this on board? As one NHS figure puts it: "Do you seriously believe they won't still scream down the phone at you?" The revolution is supposed to begin with clinical commissioning groups (CCGs) having autonomy to make their own decisions. Blackpool GP and co-chair of NHS Clinical Commissioners, Amanda Doyle, believes NHS England, which has a brief to improve health outcomes for people in England, "is very much committed to working with clinical commissioning groups. We have to give it a chance". Read the full article at the Guardian