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 __________________________________________________