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ARTICLES
Whistleblowing protection needs
teeth
20 December 2016
NHS England has strengthened whistleblowing procedures in
primary care by instructing every organisation to have a
‘Freedom to Speak Up Guardian’.
Primary care – which includes community pharmacists,
opticians and dentists as well as GP practices – is a particularly
sensitive area for whistleblowing. Unlike large hospitals, the
intimate working environment of many organisations leaves
little scope for raising concerns confidentially or anonymously.
Primary care workplaces are also less likely to offer the
protection of a trade union.
NHS England’s solution is for every primary care organisation
to identify a named individual who is neither the employer nor a
manager as ‘Freedom to Speak Up Guardian’. They have to be
in place by September 2017.
While the intentions are good, the challenges in making this
work are formidable. No doubt many organisations will
embrace it as a valuable addition to existing policies aimed at
ensuring their clinical services are safe, high quality and
ethical. But with many thousands of employers involved,
immense pressures on finances and staff time, a vocal minority
of GPs routinely opposing virtually any centrally-led initiative,
and a widespread feeling of regulator fatigue, there will be big
variations in the quality of the arrangements. A significant
weakness is that the NHS has no plans to offer confidential
legal advice to staff who want to raise concerns.
Read the full article at Public Concern at Work
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Elderly held hostage in battle for
cash
16 December 2016
The government’s refusal to find any new money for social care
will inflict significant and lasting damage on the NHS and the
lives of its patients.
The local government finance settlement announced by the
communities secretary, Sajid Javid, this week did virtually
nothing to alleviate the growing social care crisis. He simply
allowed local authorities to bring forward council tax increases
and shifted £240m from housing.
Compare that with Local Government Association figures
showing adult social care funding fell from £14.7bn in 2012-13
to £14.1bn in 2015-16, while demand continues to rise.
The government’s refusal to provide any meaningful relief for
social services is a blow to the NHS England chief executive,
Simon Stevens. Ministers have been unshakeable in their
insistence that they have given the NHS more than it asked for
to fund the Five Year Forward View transformation plan, a
position that Stevens has directly challenged in parliament.
With no likelihood of the health service getting more money
directly, Stevens had been pushing hard to get additional cash
into health and care through social services. That has now
failed.
The health and care system is now in a stand-off with the
government. Downing Street sees constant calls for more
money as no more than routine shroud-waving, and suspects
that the Sustainability and Transformation Plan initiative will
provide more of the same.
Read the full article on the Guardian Healthcare Network
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Why would clinicians become
managers?
2 December 2016
Jeremy Hunt’s attempt to distract attention from the growing
problems across the health and care system betray a poor
understanding of NHS management.
In his speech to the NHS Providers’ conference this week, Hunt
asked whether the NHS “made a historic mistake in the 1980s
by deliberately creating a manager class who were not
clinicians”.
To encourage more clinicians into management, Hunt promised
to review whether doctors and nurses are put off by the fear of
sanctions from their professional regulators if things go wrong,
and to look at whether doctors should be able to choose clinical
leadership as a specialism. These would be welcome changes,
but they would do nothing to address the fundamental reasons
why so few clinicians go into management.
At its worst, NHS management is a reputational meat grinder. A
combination of extreme financial stress, dysfunctional local
systems and a tough inspection regime that can come to
simplistic judgments means that a doctor or nurse who had
been secure in their clinical role and spent perhaps three
decades building their good name can see it pulled down in a
matter of months.
No ministerial warm words will overcome the impression made
when senior clinicians see respected peers such as Mark
Newbold at Heart of England foundation trust or Keith McNeil
at Addenbrooke’s quitting as chief executives.
Read the full article on the Guardian Healthcare Network
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NHS cannot get workforce wrong
again
18 November 2016
Ultimately, saving money in the NHS means cutting staff costs.
The NHS in England spends roughly 40% of its £121bn budget
on staff, and as local health economies try to stabilise their
finances, options such as slashing agency spending and
creating cheaper full-time roles are inevitably part of the mix.
Although clinical staff shortages are a global problem, the NHS
exacerbates the difficulties of workforce planning by constant
changes in policy. Nursing posts – currently numbering around
300,000 – have borne the brunt of this.
Having been recruited in record numbers since the 2013
publication of the Francis report into the Mid Staffordshire
scandal, nursing costs face being cut again as hospitals fight to
contain deficits.
Once upskilling was in vogue; now the latest convulsion in the
nursing profession is downskilling, with the introduction of the
post of nursing associate as trusts across the country struggle
to fill thousands of vacancies.
Health Education England is ramming this through with ill-
considered haste. In January, around a thousand trainees will
begin at pilot sites which were only announced in October,
leaving far too little time to prepare adequately for a new
discipline. A similar number of trainees follows in April, long
before any meaningful evaluation of the first wave will be
possible.
Read the full article on the Guardian Healthcare Network
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Public sector chasm threatens
NHS plan
5 November 2016
Serious tensions are emerging between the health service and
local government.
There are three sources of conflict – centrally-imposed secrecy
over the sustainability and transformation plan (STP) process,
whether the aim of STPs is to fix the NHS or develop an
integrated health and care system, and disputes over whether
the financial plans being sent to NHS England are fact or
fantasy.
At least five councils have now published the STP, despite NHS
England asking local areas to keep them hidden until the
central bodies have given their verdict.
This pointless subterfuge has put local politicians in an
invidious position; if they do as they are told they run the risk of
being accused of conniving in a cover-up of plans to shut
services. Faced with incurring the wrath of either NHS England
chief executive Simon Stevens or local voters, it is not a difficult
choice. The surprise is that more councils have not taken the
same step.
The first local authority to reveal one of the plans was
Birmingham city council. Its chief executive, Mark Rogers,
articulated publicly the frustrations many in local government
express privately.
Read the full article on the Guardian Healthcare Network
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Centre must act to make reform
happen
21 October 2016
Two years after NHS England unveiled the Five Year Forward
View – its blueprint for community-based, integrated healthcare
able to cope with the pressures of a growing and ageing
population – the central bodies are still not doing enough to
make it happen.
The King’s Fund is about to publish analysis of progress in
reforming the way the NHS works to allow the new care models
outlined in the Forward View to flourish. Speaking to the
Guardian’s Healthcare Professionals Network, chief executive
Chris Ham identified four ways in which the system is
hampering local reforms – a shortage of cash to kickstart
change, too little progress on a payment system which
encourages collaboration, the need to sort out the debacle of
the contracting rules which emerged from the Lansley reforms,
and rushing change.
“The big concern we’ve got is the importance of a
transformation fund to prime new care models. Virtually all the
money in the Sustainability and Transformation Fund is going
into sustainability and deficit reduction. It leaves precious little
left over to support transformation,” he says.
Read the full article on the Guardian Healthcare Network
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Is Health in Care Homes a quick
win?
19 October 2016
Among the vanguard models, the six test sites focused on
improving the health of care home residents – Enhanced
Health in Care Homes – are showing the greatest early
promise. Admittedly they arguably have the easiest job, with
something approaching a captive audience, but they are still
making the most of their opportunities.
Unlike vanguard models such as multispecialty community
providers (MCPs) or primary and acute care systems (PACS),
the care homes work is just part of wider system change.
However, as NHS England highlights in its first framework for
the Enhanced Health in Care Homes programme published in
September, they have the potential to become a core part of
these wider models.
The standards of medical and emotional care in some care
homes are an enduring and serious flaw in the care system. A
recent survey by the Alzheimer’s Society of 285 care home
managers found almost half were unhappy with the NHS care
provided, while one in five claimed that GP practices had been
charging care homes for dementia care, which should be free.
The society estimated that the total cost to care homes
amounted to around £260 million a year, with individual fees
reaching £36,000.
Read the full article on Health21
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Clinicians need a leading role in
change
7 October 2016
Inevitably the NHS reform drive got caught up in the party
conference crossfire. Diane Abbott, in her last few days as
shadow health secretary, attempted to rebrand sustainability
and transformation plans (STPs) as “secret Tory plans”, while
prime minister Theresa May made the ludicrous assertion that
the government had given the NHS “more than its leaders
asked for”, conjuring up an image of NHS England trying to
work out what to do with all the extra cash.
But clinicians as well as politicians are becoming increasingly
vocal on the current round of reform. The Royal College of GPs
is getting angry over the obsessive focus on sorting out
hospital deficits rather than transforming care. At their annual
conference this week, college chair Maureen Baker accurately
pointed out that if there is insufficient investment in general
practice, system transformation simply won’t happen, and the
whole process will have been in vain.
NHS England has expressed concern about the lack of clinical
involvement in drawing up local plans. At the recent NHS Expo,
chief nursing officer Professor Jane Cummings revealed that
she had had “mixed responses” when pushing for nurses to
have a greater role in STPs, and urged healthcare
professionals to make their voices heard.
Read the full article on the Guardian Healthcare Network
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Public Policy Media
Richard Vize