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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
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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
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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
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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
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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
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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
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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
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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
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Public Policy Media
Richard Vize