My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

Locality, Public Health and the NHS

Filed Under (Health Policy, Localities, Public Health) by Paul on 25-08-2011

The Government’s plans for radical change in the way in which public health is delivered in localities have changed less during the Government ‘reforms of its reforms’ than almost any part of its NHS programme.

There is a lesson in this rarely demonstrated ability to hold the line. Why is it that they have changed nearly everything else – including the national picture of public health – but have been able to stay constant on the radical change to localities? Read the rest of this entry »

Public Health – The Government’s reforms of its reforms – the National picture

Filed Under (Accountability, Public Health, Public service reform, Secretary of State) by Paul on 23-08-2011

In July the Government published its response to its initial reforms about public health. Whilst their original reforms had failed to excite as much public interest as their plans for GP commissioning, they did contain some very radical changes to the relationship between the Department of Health and public health.

Rather oddly, at a national level the public health reforms went in the opposite direction to those proposed for the NHS. Whereas the stated aim of the NHS reforms was to remove the Secretary of State’s accountability for the NHS (something that the 2011 reforms of their 2010 reforms changed radically), their original reforms of the Department’s relationship to public health abolished the independence of the Health Protection Agency (HPA) and brought their powers under the direct control of the Secretary of State. Read the rest of this entry »

The main role of the National Commissioning Board (NCB)? – maintaining close local control.

Filed Under (Commissioning Board, Culture of the NHS, Reform of the NHS) by Paul on 11-08-2011

This post is the second of the week exploring the role of the NCB. The NCB published its own development plan for consultation in July. It is an organisation of immense power which, if it continues to develop as it plans, will control local NHS commissioning very tightly.

Those who are familiar with NHS culture will not find this surprising. Traditionally it has always looked toward the centre for instruction and the NCB is the latest manifestation of how that central control moves into commissioning. When the power of the NHS ran through its control of secondary care provision – its centre was run through its ownership of all of those hospitals. Read the rest of this entry »

Nationalising the NHS. The role of the NHS Commissioning Board (NCB) in liberating the centre from the bother of localities.

Filed Under (Commissioning Board, Reform of the NHS) by Paul on 09-08-2011

It is now common knowledge that the Government’s NHS reform programme has been changed over the summer, and inside and outside the NHS there is an expectation that before the Health and Social Care bill goes through Parliament there will be even more changes. The precise role of clinical commissioning groups; the relationship between Monitor and commissioning; the role and function of Foundation Trusts – all of these are likely to change between now and the new year as the Bill completes its Parliamentary journey. Read the rest of this entry »

Profits; profits and health care; profits and the NHS

Filed Under (Private Sector, Reform of the NHS) by Paul on 05-08-2011

The relationship between profit, the NHS and health care is an important one. It would have been a very useful part of the Government’s narrative if there had been a real public debate about how profit and the NHS might intersect as a part of their reforms. But, as we know, they failed to engage with that narrative at all and now, given the Government has expended all of its leadership political capital on pausing the reforms, we will get no leadership from them in that debate.

It’s a debate in which the Conservative-led Government is embarrassed to engage. Read the rest of this entry »

The politics of profit in English health services

Filed Under (BMA, GPs, Private Health Care, Private Sector) by Paul on 02-08-2011

Last week I posted about a piece of research that examined public thinking about the issue of private sector health companies using staff trained within the NHS at public expense. The majority believed that doctors who made money in private practice should make some contribution to the public purse from their earnings if their training had been paid for by the public. Read the rest of this entry »