LATEST
ARTICLES
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
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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
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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
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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
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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
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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
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Public Policy Media
Richard Vize