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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________ 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 __________________________________________________