CCGs - waving or drowning under STPs? 28 September 2016 The financial ‘reset’ and the unveiling of the performance scores for clinical commissioning groups mean life is going to be even tougher for CCGs. Sackings, closures and takeovers are just some of the sanctions in prospect for clinical commissioning groups failing to hit their targets. Weeks after the Department of Health resorted to dubious financial footwork to stay within its spending limit, performance assessments and a new financial regime are exposing every weakness in the commissioning system. When NHS England unveiled the 2015-16 commissioning performance assessments, 10 CCGs were rated ‘outstanding’, a further 82 ‘good’ and 91 were found to ‘require improvement’. NHS England is taking action with each of the 26 CCGs rated as ‘inadequate’. The CCGs were judged on five criteria: whether they were well led; performance in delivering commitments and improving outcomes; financial management; planning on everything from system resilience to delivering the Forward View; and delegated functions such as commissioning primary care. To secure the top rating, everything had to be good or outstanding, while CCGs were rated inadequate if more than one component fell into that category or they were already under a central direction. Read the full article on Health21 ____________________________________________________________________ Lansley still explaining but not listening 23 September 2016 One of Andrew Lansley’s failings as health secretary was his apparent belief that the only reason he was under attack from all sides for his NHS reforms was because people had not grasped what he was trying to do. The solution was not to listen to their concerns, but for him to explain it all one more time. Four years later he is still explaining, and still not listening. Delivering the NHS Providers’ annual lecture this week Lansley failed to demonstrate any understanding that the Health and Social Care Act he drove through created huge disruption and enduring difficulties. One vignette during his speech was illuminating. He wittily deployed the Zhou Enlai line “It’s too early to say”, in relation to judging the impact of his reforms, but then bludgeoned any amusement out of it by deconstructing the precise circumstances in which the phrase had originally been used. One of his flaws is that he can never see the big picture for the detail. He never recognised the fact that each discrete part of his system may have had virtues, but when you put it all together it didn’t work. Competition has its place but not at the expense of collaboration. Autonomy for clinical commissioners sounds a powerful concept but they need organisations with the resources and geography to have clout. Having a maze of central bodies with sometimes conflicting priorities creates confusion and holds back change. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Fantasy Brexit claims face reality check 12 September 2016 As the UK government blurted out its opening Brexit negotiating position, it was becoming increasingly clear that key claims of Brexit campaigners were fantasy. Prime Minister Theresa May interprets the Brexit vote primarily as a demand by the British public to reduce immigration sharply, even at the cost of access to the single market. A key argument peddled by the Brexit campaigners was that Europe needs us more than we need them – because of the balance of trade – so self-interest will ensure they still give us access to the single market even as we clamp down on EU immigration. But, to May’s irritation, Brexit minister and Vote Leave campaigner David Davis has told the House of Commons it would be “very improbable” that the UK would retain access to the single market if it imposed immigration controls. The second Brexit myth exposed in recent days is that the rest of the world would shrug off any concerns about Brexit because they would see that “Britain is open for business”. Japan is unimpressed; it sent a tough 15-page message to the UK warning that major companies might want out if EU laws cease to apply to the UK. This threat has substance. Doubt over UK access to the single market is already jeopardising investment by Nissan, which supports thousands of British jobs. A decision is likely by early 2018, when the UK will still be months away from a Brexit deal. We are not having much luck elsewhere. It transpires that President Obama wasn’t kidding when he said we would be at the back of the queue for a trade deal, while Australia (10,000 miles from the UK compared with 21 to Europe) has pointed out that it will also focus on securing a trade deal with Europe before turning to the UK, which will in any event have to wait until it has left the EU. Davis insisted to the UK Parliament that Brexit was about a lot more than making the best of a bad job. The evidence so far is unconvincing. Published in Parliament magazine, Brussels ____________________________________________________________________ Secrecy is overshadowing NHS reforms 9 September 2016 The NHS is in danger of losing control of public debate around the sustainability and transformation plans (STPs). Days after the unnecessary secrecy around STP blueprints for change predictably backfired, with lurid headlines about closures and cuts, both NHS England and the government have been trying to get a grip on public understanding of what all this frantic management work is trying to achieve. At this week’s Health and Care Innovation Expo in Manchester, NHS England chief executive Simon Stevens said that in the next few days his organisation will be spelling out expectations on how the public will be involved in discussions. This is a reversal of its previous position, which was to discourage STPs from publishing their draft plans. Meanwhile, at prime minister’s questions, STPs put the prime minister, Theresa May, on the defensive, forcing her to reiterate the importance of taking into account the concerns of local people. The emerging plans are sensitive because a large number involve substantial changes to hospital services. It is far from clear how many of these will eventually go ahead, because there is a desperate shortage of capital funding with which to implement them. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Hunt can’t bully through seven day plan 26 August 2016 The Guardian’s revelation of the Department of Health’s analysis of the risks around seven-day working exposes how a highly political health secretary is meeting his nemesis in the hard graft of policy implementation. There is nothing remarkable about the existence of a risk register; identifying a range of potentially serious problems is standard practice for any government policy. What is striking is that 13 major risks are rated red or red/amber – meaning they are very likely or likely to occur. Translating Whitehall-speak into plain English, the document tells us that ministers are not sure what they are trying to achieve, that in all likelihood seven-day working will make little difference to hospital services, that there is little agreement on how it should be delivered, plans that do exist are of poor quality, and there are not enough NHS staff in place to make it all happen. In short, this is a policy – and a health secretary – in crisis. Jeremy Hunt has been trying to batter seven-day working through by winning the propaganda war with the junior doctors over the introduction of new contracts, and doing so by misrepresenting the evidence. Listening to Hunt, the casual observer would assume that the only thing standing between today’s NHS and effective seven-day working is changing doctors’ shift patterns. This document reveals far more serious obstacles. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ More talk than action on mental health 29 July 2016 Promises, platitudes and plans are piling up for mental health, but how much is going to be delivered? Mental health accounts for roughly £12bn of the NHS budget. In parliamentary terms the current support for mental health is unprecedented – parity of esteem with physical health services is enshrined in the Health and Social Care Act 2012, plus last year’s spending review made explicit reference to improving quality, choice and outcomes in mental health. But a recent report by the health select committee on the impact of the spending review on health and social care was sceptical about whether the rhetoric is being matched by actions. The committee called for verifiable evidence that the additional cash promised to mental health was reaching the front line, and that the cultural change necessary to deliver parity of esteem was happening. The NHS planning guidance for 2016-21 instructs clinical commissioning groups to increase investment in mental health at least at the level which matches their overall spending increase, but whether this being done is disputed. NHS clinical commissioners insisted to MPs that this is happening while NHS Providers maintained the money is not coming through. It even accused commissioners of using “weird and wonderful calculation methodology” to justify their claims. Read the full article on the Guardian Healthcare Network ____________________________________________________________________ Financial woes undermine quality drive 29 July 2016 The announcement by NHS England and NHS Improvement of a “reset” of NHS finances to try to cut deficits, as well as the accusation that 63 trusts were guilty of excessive growth in their pay bill, can be seen as the end of the policy drive around quality and safety that followed the Mid Staffordshire scandal. When Jeremy Hunt succeeded Andrew Lansley as health secretary for England, his determination to obliterate discussion of health reforms by attacking Labour’s record on quality meant that clinicians and managers quickly concluded that running up deficits by recruiting staff was preferable to being identified as “the next Mid Staffs.” The safety debate quickly morphed into more staff being equated with higher care standards, while years of poor workforce planning and stagnating pay left trusts in a bidding war to employ unsustainable numbers of nurses and doctors through agencies. Meanwhile, funding for treatment episodes has been reduced under the guise of efficiency savings as demand rises. Acute trusts ended last year overwhelmingly in deficit, and increasing numbers of clinical commissioning groups are in trouble. As NHS England’s chief executive, Simon Stevens, has mentioned, central bodies are being forced to drive through funding levels they never signed up to: the aim set out in the Five Year Forward View in October 2014, of 2% annual efficiency gains, assumed sustained social care funding and investment in prevention. Both have been cut substantially. Read the full article on BMJ.com ____________________________________________________________________ What lies in store for reappointed Hunt 15 July 2016 Theresa May’s reappointment of Jeremy Hunt as health secretary after almost four years in post is an endorsement of the political talents of a minister who is in serious difficulty on three fronts – industrial relations, funding and reform. The length of time Hunt spent in Downing Street on the morning of his appointment may indicate the depth of the new prime minister’s concern about what she faces in the NHS. His first priority must be to end the dispute with junior doctors. The new administration is already fighting on too many fronts; medical staff back on picket lines is a problem it will be desperate to avoid. Hunt announced that he was going to impose a new contract  on the doctors after the deal he negotiated with the BMA was rejected in a ballot. The dispute is more than just discordant background music; junior doctors feeling alienated seriously impedes reform of NHS services. Crucially, Hunt stands accused by the doctors of misrepresenting evidence about hospital patient outcomes at weekends, and how that relates to the seven-day working he wants to introduce. If he is going to make any progress in rebuilding trust and finding a way forward which does not involve more strikes, he would be wise to concede some mistakes in the way he has handled the dispute. Read the full article on the Guardian Healthcare Network