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 »

When 360 degree assessment might just become very important

Filed Under (Accountability, Clinical Commissioning Groups, National Commissioning Board) by Paul on 28-11-2012

Following on from my post on Monday about the way in which local CCGs might use the Secretary of State’s mandate to hold the NCB to account, I have had my attention drawn to some activity from the CCGs themselves. I was suggesting that since the mandate lays a number of responsibilities on the NCB to listen to the changes that the CCGs say are necessary to bring about integrated care, the CCGs could use it to hold the NCB to account. Read the rest of this entry »

Turning the tables. How might CCGs use the Secretary of State’s mandate to hold the National Commissioning Board to account?

Filed Under (Clinical Commissioning Groups, Health Policy, National Commissioning Board, Secretary of State) by Paul on 26-11-2012

This is my third post about the mandate because I think this is such an important part of the new NHS architecture. This one is looks at it from a different point of view – in a way that could turn the whole politics of the mandate on its head. Read the rest of this entry »

Another New Venture

Filed Under (Health Improvement, Healthcare delivery, Integration) by Paul on 22-11-2012

Regular readers of my blog will recall that I have been saying for some time that the NHS is going to need some help from beyond its culture. This is specifically the case when it is developing something that is both as new and as difficult as integrated care for NHS patients.  I have written a few times about the need for organisations to specifically act as integrators bringing very different providers together to create a patient pathway.

From today I, and a few others, are setting up a company called LTC Ltd. as one of these integrators. Our aim is to help develop integrated care for NHS patients. The company, and myself as a part of it, will be bidding for work from NHS commissioners.

I wanted to make my part in this new venture public at the earliest opportunity.

The web site should be up later today at

How CCGs can stick to their mandate and develop patient-led value for the NHS.

Filed Under (Clinical Commissioning Groups, GP Commissioning, Health Improvement, National Commissioning Board, Patient involvement, Self Management) by Paul on 21-11-2012

This evening, at about 18.15, I am speaking to the NHS Alliance conference in Bournemouth. My theme tonight, as it has been for some time now, is how the NHS can develop better public value by viewing people with long-term conditions as ‘assets’ rather than as ‘costs’. Read the rest of this entry »

How might last week’s mandate from the Secretary of State impact upon the NHS over the next few years? How can it make integrated care a reality?

Filed Under (Clinical Commissioning Groups, Integration, National Commissioning Board) by Paul on 19-11-2012

One of the main consequences of last year’s pause in the passage of the Health and Social Care Bill was a blizzard of amendments to the statutory duties of every single NHS organisation. Amongst the many contradictions that arose from these amendments, there was one constant. By the time it became an Act, after the Bill was amended and re-amended in the Lords every single possible organisation had had a duty to create integrated care laid upon it.

Last week’s mandate for the NCB from the Secretary of State has begun to put some flesh on the bones of how it will be expected to carry this out,

2.1 We want to empower and support the increasing number of people living with long term conditions. One in three people are living with at least one chronic disease. By 2018 nearly 3 million people, mainly older people, will have three or more conditions all at once

2.7 As a leader of the health system, the NHS Commissioning Board is uniquely placed to co ordinate a major drive for better integration of care across different services, to enable local implementation at scale and with pave from April 2013

2.8 The focus should be on what we are achieving for individuals rather than for organisations- in other words care that feels more joined up to the users of services with the aim of maintaining their health and well being and preventing their condition deteriorating as far as possible. We want to see improvements in the way that care

  • Is coordinated around the needs, conveniences and choices of patients, their carers and families- rather than the interests of the organisations that provide care
  • Centres on the person as a whole rather than on specific conditions
  • Ensure people experience smooth transitions between care settings and organisations including between primary and secondary care, mental and physical health services, children’s and adult services and healthy and social care- thereby to reduce health inequalities
  • Empowers service users so that they are better equipped to manage their own care as far as they want and are able to.

The NCB will quite rightly pass many of the main ways to implement this mandate onto CCGs. I will explore in a later post what that might mean.

But the NCB is not only a performance manager of CCGs it is also commissions health care itself.

The NCB commissions £12 billion of specialist health care. If it takes the Secretary of State’s mandate seriously we would expect to see this enormous buying power used to ensure that the services that it buys bought from specialised providers would be part of an integrated care pathway.

This will not be easy (but NOTHING about creating integrated care in the NHS will be easy) because most specialist commissioning is a specific episode of care. However specialist episodes of care, like all other care, need to be part of a pathway of care. The NCB will have to put these episodes alongside the care before, and especially after, the specialist episode to turn it into a pathway. This will be difficult because care on both sides of specialist episodes will be commissioned by local commissioners (CCG and local authority).

But if the NCB wants to demonstrate how it is carrying out its mandate it will have to make this happen.

However there is a much more direct impact that the NCB has through the £20+ billion of GP services that they buy. (One of the odder aspects of this localising reform was the nationalisation of the commissioning of GP services that has taken place.)

GPs will be key to integrated care. Indeed it is very difficult to understand how there can be an integrated care pathway without them.

So if the NCB is going to carry out its statutory duty to develop integrated care, and if it is going to play its role in developing that part of the mandate on integrated care, it will need to radically develop the GP contract. That contract, like every other part of the NHS needs to contain incentives to develop integrated, not just episodic, care. Read the rest of this entry »

What’s wrong with modern health systems – an analogy. Plus an explanation of what I mean by the cost and price of failure in the NHS and the Canadian health system.

Filed Under (Canada, Health Improvement, Resources) by Paul on 15-11-2012

Whilst in Canada I spoke at a conference run by the Ontario Hospital Association (the equivalent of our Confederation but only covering hospitals). The opening speaker was Don Berwick who, whilst being from the US is no stranger to the NHS and its reform. Don helped to set up one of the best health improvement organisations in the world – the Institute of Health Improvement (the IHI, the website is well worth a visit) and it was as the IHI that he spent much of the late 90s and the first decade of this century helping the NHS. Read the rest of this entry »

Reform and Healthcare in Canada

Filed Under (Canada, Healthcare delivery, Public Health, Public service reform) by Paul on 12-11-2012

I spent last week in Canada talking to people engaged in health care reform in the provinces of Ontario and Quebec. Canada has a socialised medicine system with a lot of similarities to the UK system. The very existence of a socialised medicine system is very important to most Canadians.  Many would say that it is their socialised medicine system that differentiates them from the USA. Read the rest of this entry »

An example of local health and health care leadership from Clinical Commissioning Groups.

Filed Under (Clinical Commissioning Groups) by Paul on 07-11-2012

On Monday I pointed out the obvious fact that new forms of commissioning will not stop mistakes being made by commissioners. Indeed with 220 brand new organisations taking new responsibilities one might expect there to be a few more.

But as I said in that post I also have no doubt that some CCGs will be developing the necessary radical new approaches to health care. It is not just because CCGs have a number of clinicians in their leadership, but it is also the case that those GP leaders have usually been a part of their locality for decades. They know the area, as well as knowing their patients. Read the rest of this entry »

Two years too late the Government is starting to develop a narrative to explain its NHS reforms – and having it may be even more troublesome.

Filed Under (Clinical Commissioning Groups, Narrative of reform) by Paul on 05-11-2012

I don’t generally blow my own trumpet but if you look at my post of September 14 2010 I think it contained the first comment anywhere pointing out that the Government did not have a narrative to explain why its NHS reforms were necessary. Since the Government did not have a reason for its reforms how could it explain how they would deal with what was wrong? Over the following 20 months it was open season on their inability to communicate either what was wrong, or how their reforms were going to put it right. Read the rest of this entry »