Richard Vize Public Policy Media Ltd
LATEST ARTICLES
CV
Devolution offers rare reform chance 31 October 2014 A rare opportunity has opened up in the 40-year struggle to devolve more power to England’s towns and cities and finally make local government finance self-sufficient. As Labour leader Ed Miliband announces a sweeping set of policies to transfer more power to local regions, now is the time to seize the chance created by the devolution debate and the need to get public services through another five years of cuts. The Independent Commission on Local Government Finance’s interim report, Public Money, Local Choice, which I helped draft, wants to secure radical change to the relationship between central and local government - nothing less than making local government financially self-sufficient. The commission, chaired by former senior public servant Darra Singh, was set up in June 2013 by the Local Government Association and public sector accountancy body CIPFA to tackle the urgent issue of how to reform local government funding. Its proposed reforms are designed to support five key national policy objectives – growing the economy, increasing housing, integrating health and social care, promoting work while protecting the vulnerable and supporting families and children through early intervention. Read the full article on the Guardian Public Leaders Network ____________________________________________________________________ Pressure on to develop new care models 30 October 2014 Among the scores of commitments to reform which came tumbling out of NHS England’s Five Year Forward View last week, a picture emerges of how the national bodies are going to leverage reforms among both the high- performers and the strugglers. At the struggling end, the national bodies have promised to take a joined-up approach to addressing weaknesses across whole health economies rather than separately targeting failing organisations. With 18 clinical commissioning groups expecting to end the financial year in deficit, and around another 30 perilously close, there will not be a shortage of candidates to test this approach. The frequent inability of NHS England, the Care Quality Commission, NHS Trust Development Authority and Monitor to coordinate their work around failing organisations and systems is a routine source of complaint among providers and clinical commissioners. When the sharp end of the NHS is under ever greater pressure to collaborate and integrate, it seems odd that the national bodies have not been leading by example. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Can Darzi plan improve London’s health? 16 October 2014 London’s healthcare consumes around a fifth of the NHS budget for England. On Wednesday, at the behest of mayor Boris Johnson, eminent surgeon Lord Darzi launched his second plan in seven years for wholesale reform of the city’s health systems. London’s NHS is a patchwork of brilliance and failure; loss-making hospitals with seemingly intractable care quality problems sit alongside trusts providing some of the finest specialist care in the world. Networks of GPs achieving extraordinary results in some of the poorest communities in Britain work down the road from practices with a single GP that should not be part of 21st-century healthcare. Seven years ago Darzi published his Framework for Action, commissioned by NHS London. Then, his plan for moving substantial care from hospitals to GP-led polyclinics was largely thwarted by GP opposition, but his call for trauma, hyper acute stroke and heart attack services to be centralised in specialist units achieved results that attracted international attention. Moves to rationalise acute services further were blocked by Andrew Lansley when he became health secretary in 2010. Johnson asked Darzi to lead his London Health Commission to fill a vacuum. The abolition of NHS London has left the capital with no strategic direction and no one with the clout to drive through change. Johnson is attempting to exert influence far beyond his formal powers. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Tory and Labour policies don’t add up 2 October 2014 The NHS will be at the centre of the general election campaign. During the party conferences Labour and the Tories each used the same brutal, disingenuous techniques to win the argument – low blows aimed at inducing fear about their opponent’s record followed by promises of more staff and better services built on a financial mirage. There was nothing in Labour leader Ed Miliband’s speech – even the version including the bits he forgot – that came close to being a coherent plan for running effective public services while meeting his party’s promise to eliminate the deficit. There barely a hint of the difficult choices to come. The shadow health secretary, Andy Burnham, also swerved round the growing financial crisis to concentrate on his vision of bringing health and social care into a single service. His big idea is for hospital trusts to evolve into integrated care organisations, meeting virtually all physical, mental and social care needs. This vision has appeal, but the policy is beset by dodgy reasoning to make it add up. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Dogmatic bullies suppress local debate 2 October 2014 As Scotland attempts to come to terms with the result of its independence referendum, it’s trying to find where robust political debate morphs into bullying. In her now-famous tweet in support on the no vote, novelist J K Rowling said “whatever happens, I hope we’re all friends by Saturday”. It’s a sentiment that might be echoed in local authorities around the country, where there is no shortage of evidence that bust-ups often supersede listening – even to your own side. This was recently laid bare in a peer review of Thanet district council. “Barracking, bullying and talking over others are behaviours which … damage the council’s reputation. There are things that all councillors can and should do … including listening respectfully to the contributions of others [and] avoiding the use of personal insults.” Robust political debate is the heartbeat of local government, but too often it mutates into the dogmatic application of power. If local government is to survive the permafrost of austerity, it needs a more engaging political culture that is open to ideas and encourages innovation and experimentation. Old-style politics is inhibiting the radical change needed in the face of relentless cuts. Read the full article on the Guardian Public Leaders Network ____________________________________________________________________ Heroic optimism fires Better Care Fund 18 September 2014 The deadline for submitting redrafted plans for the £3.8bn Better Care Fund is on Friday. But strategies for five fast-track areas have just been approved, revealing what this controversial scheme, the biggest ever push to integrate health and social care, might achieve. The fund’s programme team – supported by NHS England, the Local Government Association and Department of Health – is wary of wildly optimistic claims about what can be done in 2015-16; one of the criteria is that delivery mechanisms must be “believable”. But after protracted lobbying by hospitals over the need for them to secure tangible benefits – since they are funding half the bill – the guidance also pushes local areas to make bullish predictions on reducing emergency admissions, with a target of at least 3.5%. For most hospitals, simply slowing or stopping the admissions increase is tough; a substantial cut is the stuff of dreams. The plans just approved cover Nottinghamshire, Sunderland, Greenwich, Reading and Wiltshire. They are a blend of innovation and caution, leavened with dollops of heroic optimism. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Barker confronts long-term care wrongs 4 September 2014 The commission on the future of health and social care in England, established by the King’s Fund under economist Kate Barker, has unveiled a radical but deliverable plan for extending free at the point of need care into social services. The commission’s final report shuns the usual obsession with how to fund hospitals, instead focusing on the needs of patients with long-term conditions. It was heavily influenced by the emotionally charged evidence from its panel of service users and carers. Their distress, despair, sense of injustice and incomprehension at the unfairness of the current system drove the commission to look for a new approach, built around patient needs rather than the current arbitrary and irrational distinctions between health and social care. The commission is right to confront the injustice of those with conditions such as Parkinson’s, Alzheimer’s and motor neurone disease being financially penalised simply for having the wrong type of illness. This unfairness is compounded by having to pay for a system that fails to provide joined-up care. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Tough lesson of Manchester reform plan 7 August 2014 The backlash over plans to reconfigure hospitals and primary care in Greater Manchester is a warning of what can go wrong if consultations are mishandled. The plan – badged Healthier Together – was launched last month by the area's 12 clinical commissioning groups. There are four problems: the consultation document is vague and confusing; they are not being up-front about the need to cut costs; it has provoked a fight between four foundation trusts (FTs); and the proponents of change have alienated local MPs, who have torn into the exercise. The consultation document repeats a mistake made in other reconfiguration controversies in being concrete about what will be closed or downgraded but vague about the benefits, notably around primary and community care. The primary care standards and warm words about joint working mean little, and the scattergun examples of local progress do not add up to a Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Professional regulation demands reform 24 July 2014 Professional regulation faces a collapse in public confidence. The regulators, clinicians and the public all see an urgent need for a major overhaul of the oversight of professional standards. What is needed most of all is government action. Despite its fusty image, professional regulation has been changing rapidly this century. Organisations dominated by professionals regulating their own colleagues have evolved into patient-centred bodies with strong lay representation and more transparent processes. Organisations such as the General Medical Council, Nursing and Midwifery Council and General Dental  Council talk to patients, the public and employers more than ever, and the health select committee has strengthened their accountability to parliament. But this is not enough. As a recent Public Policy Projects discussion at the House of Commons on regulation heard, archaic legislation traps regulators into "fitness to practise" procedures that take far too long, creating an injustice for complainant and clinician alike. Some regulators are prohibited from investigating problems exposed by the media or their own contacts unless there is a formal complaint. Collaboration between different parts of the healthcare regulatory system is being impeded. Money is being wasted. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Better Care Fund exposes culture clash 10 July 2014 The biggest ever push to integrate health and social care is in serious difficulty. What has gone wrong with the Better Care Fund and can it be fixed? The difficulty stems from the fact that half of the basic £3.8bn fund, intended to support integration projects in 2015-16, has been stripped out of budgets for acute health services. The hospital lobby argued that this risked pushing providers further into financial difficulty. The government has responded with a clawback mechanism which will keep £1bn of it largely in the NHS and make it dependent on achieving locally agreed reductions in hospital admissions. In response, David Sparks, in his first speech as the new Labour leader of the Local Government Association (LGA), told its annual conference on Tuesday: "We are seeing Whitehall trying to strangle [the fund] at birth." The increasingly bitter tone of the dispute reflects the massive financial stress facing both the NHS and local government. It is akin to drowning sailors fighting over a lifebelt. But it is also a clash of cultures and perspectives. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Fatal flaws in city empowerment plans 4 July 2014 Labour's proposals to devolve power to large cities are a blueprint for a continuation of central control. A radically different approach would be needed to shift power out of Whitehall. Labour and Tory spokespeople have struggled to differentiate their devolution policies. The Conservative minister for cities, Greg Clark, the former Labour cabinet minister Lord Adonis and Tory grandee Lord Heseltine are essentially reading from the same script (although Heseltine is the most radical, as he calls for £50bn of central government spending to be devolved to councils and local enterprise partnerships). They are all similarly flawed: they offer centralist prescriptions for localism, built on the idea that Whitehall gives permission for cities and regions to act. They do not offer a blueprint to embed power outside government departments. The Adonis report dissects the flaws in the approach, in which councils spend anything up to 18 months negotiating with often hostile government departments to secure vague promises of more wriggle room. But there is nothing in his proposals to indicate that it would be any different under Labour. Read the full article on the Guardian Local Government Network
July to October 2014
Richard Vize Public Policy Media Ltd
LATEST ARTICLES
CV
Devolution offers rare reform chance 31 October 2014 A rare opportunity has opened up in the 40-year struggle to devolve more power to England’s towns and cities and finally make local government finance self-sufficient. As Labour leader Ed Miliband announces a sweeping set of policies to transfer more power to local regions, now is the time to seize the chance created by the devolution debate and the need to get public services through another five years of cuts. The Independent Commission on Local Government Finance’s interim report, Public Money, Local Choice, which I helped draft, wants to secure radical change to the relationship between central and local government - nothing less than making local government financially self-sufficient. The commission, chaired by former senior public servant Darra Singh, was set up in June 2013 by the Local Government Association and public sector accountancy body CIPFA to tackle the urgent issue of how to reform local government funding. Its proposed reforms are designed to support five key national policy objectives – growing the economy, increasing housing, integrating health and social care, promoting work while protecting the vulnerable and supporting families and children through early intervention. Read the full article on the Guardian Public Leaders Network ____________________________________________________________________ Pressure on to develop new care models 30 October 2014 Among the scores of commitments to reform which came tumbling out of NHS England’s Five Year Forward View last week, a picture emerges of how the national bodies are going to leverage reforms among both the high-performers and the strugglers. At the struggling end, the national bodies have promised to take a joined-up approach to addressing weaknesses across whole health economies rather than separately targeting failing organisations. With 18 clinical commissioning groups expecting to end the financial year in deficit, and around another 30 perilously close, there will not be a shortage of candidates to test this approach. The frequent inability of NHS England, the Care Quality Commission, NHS Trust Development Authority and Monitor to coordinate their work around failing organisations and systems is a routine source of complaint among providers and clinical commissioners. When the sharp end of the NHS is under ever greater pressure to collaborate and integrate, it seems odd that the national bodies have not been leading by example. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Can Darzi plan improve London’s health? 16 October 2014 London’s healthcare consumes around a fifth of the NHS budget for England. On Wednesday, at the behest of mayor Boris Johnson, eminent surgeon Lord Darzi launched his second plan in seven years for wholesale reform of the city’s health systems. London’s NHS is a patchwork of brilliance and failure; loss- making hospitals with seemingly intractable care quality problems sit alongside trusts providing some of the finest specialist care in the world. Networks of GPs achieving extraordinary results in some of the poorest communities in Britain work down the road from practices with a single GP that should not be part of 21st-century healthcare. Seven years ago Darzi published his Framework for Action, commissioned by NHS London. Then, his plan for moving substantial care from hospitals to GP-led polyclinics was largely thwarted by GP opposition, but his call for trauma, hyper acute stroke and heart attack services to be centralised in specialist units achieved results that attracted international attention. Moves to rationalise acute services further were blocked by Andrew Lansley when he became health secretary in 2010. Johnson asked Darzi to lead his London Health Commission to fill a vacuum. The abolition of NHS London has left the capital with no strategic direction and no one with the clout to drive through change. Johnson is attempting to exert influence far beyond his formal powers. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Tory and Labour policies don’t add up 2 October 2014 The NHS will be at the centre of the general election campaign. During the party conferences Labour and the Tories each used the same brutal, disingenuous techniques to win the argument – low blows aimed at inducing fear about their opponent’s record followed by promises of more staff and better services built on a financial mirage. There was nothing in Labour leader Ed Miliband’s speech – even the version including the bits he forgot – that came close to being a coherent plan for running effective public services while meeting his party’s promise to eliminate the deficit. There barely a hint of the difficult choices to come. The shadow health secretary, Andy Burnham, also swerved round the growing financial crisis to concentrate on his vision  of bringing health and social care into a single service. His big idea is for hospital trusts to evolve into integrated care organisations, meeting virtually all physical, mental and social care needs. This vision has appeal, but the policy is beset by dodgy reasoning to make it add up. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Dogmatic bullies suppress local debate 2 October 2014 As Scotland attempts to come to terms with the result of its independence referendum, it’s trying to find where robust political debate morphs into bullying. In her now-famous tweet in support on the no vote, novelist J K Rowling said “whatever happens, I hope we’re all friends by Saturday”. It’s a sentiment that might be echoed in local authorities around the country, where there is no shortage of evidence that bust-ups often supersede listening – even to your own side. This was recently laid bare in a peer review of Thanet district council. “Barracking, bullying and talking over others are behaviours which … damage the council’s reputation. There are things that all councillors can and should do … including listening respectfully to the contributions of others [and] avoiding the use of personal insults.” Robust political debate is the heartbeat of local government, but too often it mutates into the dogmatic application of power. If local government is to survive the permafrost of austerity, it needs a more engaging political culture that is open to ideas and encourages innovation and experimentation. Old-style politics is inhibiting the radical change needed in the face of relentless cuts. Read the full article on the Guardian Public Leaders Network ____________________________________________________________________ Heroic optimism fires Better Care Fund 18 September 2014 The deadline for submitting redrafted plans for the £3.8bn Better Care Fund is on Friday. But strategies for five fast-track areas have just been approved, revealing what this controversial scheme, the biggest ever push to integrate health and social care, might achieve. The fund’s programme team – supported by NHS England, the Local Government Association and Department of Health – is wary of wildly optimistic claims about what can be done in 2015-16; one of the criteria is that delivery mechanisms must be “believable”. But after protracted lobbying by hospitals over the need for them to secure tangible benefits – since they are funding half the bill – the guidance also pushes local areas to make bullish predictions on reducing emergency admissions, with a target of at least 3.5%. For most hospitals, simply slowing or stopping the admissions increase is tough; a substantial cut is the stuff of dreams. The plans just approved cover Nottinghamshire, Sunderland, Greenwich, Reading and Wiltshire. They are a blend of innovation and caution, leavened with dollops of heroic optimism. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Barker confronts long-term care wrongs 4 September 2014 The commission on the future of health and social care in England, established by the King’s Fund under economist Kate Barker, has unveiled a radical but deliverable plan for extending free at the point of need care into social services. The commission’s final report shuns the usual obsession with how to fund hospitals, instead focusing on the needs of patients with long-term conditions. It was heavily influenced by the emotionally charged evidence from its panel of service users and carers. Their distress, despair, sense of injustice and incomprehension at the unfairness of the current system drove the commission to look for a new approach, built around patient needs rather than the current arbitrary and irrational distinctions between health and social care. The commission is right to confront the injustice of those with conditions such as Parkinson’s, Alzheimer’s and motor neurone disease being financially penalised simply for having the wrong type of illness. This unfairness is compounded by having to pay for a system that fails to provide joined-up care. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Tough lesson of Manchester reform plan 7 August 2014 The backlash over plans to reconfigure hospitals and primary care in Greater Manchester is a warning of what can go wrong if consultations are mishandled. The plan – badged Healthier Together – was launched last month by the area's 12 clinical commissioning groups. There are four problems: the consultation document is vague and confusing; they are not being up-front about the need to cut costs; it has provoked a fight between four foundation trusts (FTs); and the proponents of change have alienated local MPs, who have torn into the exercise. The consultation document repeats a mistake made in other reconfiguration controversies in being concrete about what will be closed or downgraded but vague about the benefits, notably around primary and community care. The primary care standards and warm words about joint working mean little, and the scattergun examples of local progress do not add up to a Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Professional regulation demands reform 24 July 2014 Professional regulation faces a collapse in public confidence. The regulators, clinicians and the public all see an urgent need for a major overhaul of the oversight of professional standards. What is needed most of all is government action. Despite its fusty image, professional regulation has been changing rapidly this century. Organisations dominated by professionals regulating their own colleagues have evolved into patient-centred bodies with strong lay representation and more transparent processes. Organisations such as the General Medical Council, Nursing and Midwifery Council and General Dental Council talk to patients, the public and employers more than ever, and the health select committee  has strengthened their accountability to parliament. But this is not enough. As a recent Public Policy Projects discussion at the House of Commons on regulation heard, archaic legislation traps regulators into "fitness to practise" procedures that take far too long, creating an injustice for complainant and clinician alike. Some regulators are prohibited from investigating problems exposed by the media or their own contacts unless there is a formal complaint. Collaboration between different parts of the healthcare regulatory system is being impeded. Money is being wasted. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Better Care Fund exposes culture clash 10 July 2014 The biggest ever push to integrate health and social care is in serious difficulty. What has gone wrong with the Better Care Fund and can it be fixed? The difficulty stems from the fact that half of the basic £3.8bn fund, intended to support integration projects in 2015-16, has been stripped out of budgets for acute health services. The hospital lobby argued that this risked pushing providers further into financial difficulty. The government has responded with a clawback mechanism which will keep £1bn of it largely in the NHS and make it dependent on achieving locally agreed reductions in hospital admissions. In response, David Sparks, in his first speech as the new Labour leader of the Local Government Association (LGA), told its annual conference on Tuesday: "We are seeing Whitehall trying to strangle [the fund] at birth." The increasingly bitter tone of the dispute reflects the massive financial stress facing both the NHS and local government. It is akin to drowning sailors fighting over a lifebelt. But it is also a clash of cultures and perspectives. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Fatal flaws in city empowerment plans 4 July 2014 Labour's proposals to devolve power to large cities are a blueprint for a continuation of central control. A radically different approach would be needed to shift power out of Whitehall. Labour and Tory spokespeople have struggled to differentiate their devolution policies. The Conservative minister for cities, Greg Clark, the former Labour cabinet minister Lord Adonis and Tory grandee Lord Heseltine are essentially reading from the same script (although Heseltine is the most radical, as he calls for £50bn of central government spending to be devolved to councils and local enterprise partnerships). They are all similarly flawed: they offer centralist prescriptions for localism, built on the idea that Whitehall gives permission for cities and regions to act. They do not offer a blueprint to embed power outside government departments. The Adonis report dissects the flaws in the approach, in which councils spend anything up to 18 months negotiating with often hostile government departments to secure vague promises of more wriggle room. But there is nothing in his proposals to indicate that it would be any different under Labour. Read the full article on the Guardian Local Government Network