LATEST ARTICLES
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
July to September 2016
Public Policy Media
Richard Vize