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 »

Hospitals – keeping them open, or changing them radically.

Filed Under (Hospitals, Localities) by Paul on 30-01-2013

The last few days have seen some very important disagreements about the extent to which NHS hospitals need to be changed. Last week’s Guardian was full of the call for change from Bruce Keogh, the National Commissioning Board’s Medical Director. He took the fight to politicians by saying that by defending local interests MPs risked consigning their local hospital to “perpetual mediocrity”. Read the rest of this entry »

Take a few steps back to understand what failing hospitals really mean for the NHS – and why we need to do something serious when they do.

Filed Under (Francis Report, Healthcare delivery, Hospital Trusts, Localities) by Paul on 28-01-2013

Last week I drew the analogy between the role of the administrator in the NHS and the fact that someone with the same name – administrator – winds up High Street retail chains like HMV. The point I was trying to make was that the announcement of an administrator for HMV was recognised as being the end of the line for the current organisation of a failed chain of stores. However when an administrator  was announced for South London Healthcare Trust it was seen as another opportunity to develop the trust with the minimal amount of change. Read the rest of this entry »

When is an NHS reorganisation not an NHS reorganisation?

Filed Under (Health and Social Care Act, Health Policy, Labour Party, Local Government, Localities, Reform of the NHS) by Paul on 05-10-2012

Andy Burnham made an important speech to Conference about the Labour Party’s policy on health services. In doing so demonstrated why it’s important for opposition parties not to announce policy specifics 30 months before the election. What he has discovered is that when you announce one big thing it leads to a whole host of questions about everything else. .

He announced a number of things that will now be probed in great detail. Read the rest of this entry »

What happened to the South London NHS trust yesterday – and why was it so important?

Filed Under (Expenditure, Localities, Resources) by Paul on 27-06-2012

First I should say that I have some historical interest here. I was an executive director in the London SHA when this trust was created by the merger of three existing trusts. The trusts that were merged were not viable. But the trust that the merger created has also turned out not to be viable and I think we should have been more aware of this at the time. When the NHS did not really know what to do it merged problem hospitals into a single institution. (As you will see from my comments below, this is something the NHS still does all the time). Read the rest of this entry »

Q. What are the two things that could survive a nuclear holocaust?

Filed Under (Localities, National Commissioning Board, Regional Health Authorities) by Paul on 26-04-2012

A. Cockroaches and Regional Health Authorities.

I must right away give acknowledgement to the author of this joke. It comes from Nigel Edwards who worked for the NHS Confederation for a long time and has seen his fair share of NHS reorganisations. Read the rest of this entry »

A New Ally for Local Clinical Commissioning Groups – Local Government

Filed Under (Commissioning Board, GP Commissioning, Localities) by Paul on 20-09-2011

Regular readers will recognise that one of the themes of this blog over the last 9 months has been how, despite the heady intentions of the Secretary of State in July 2010 to localise power in the NHS, recent practice in setting up the reforms has been to give ever greater power to the centre – in the shape of the National Commissioning Board.

My recent experience within the reform programme of the NHS has underlined the impact this is having on local experience. Just in the last few weeks a number of GP leaders of local commissioning groups have expressed surprise at how they are being treated by the local arms of the NCB (in the shape of clustered PCTs and SHAs). They are being told to come to meetings at a few hours notice; to change their plans at a weekend’s notice and generally getting a good introduction to the centrist culture of the NHS. Up until now most GPs have avoided this experience because the NHS centre has not seen them as being sufficiently powerful to bother with.

Now they are being put ‘in charge’ of local commissioning they are beginning to experience the combination of instruction and capriciousness that is the hallmark of central NHS management culture and, unsurprisingly, it’s a bit of a shock.

GPs say in wonderment, this can’t really be an example of what the Government means by localisation can it? And of course they have a point.

Since December last year when the quid pro quo for going ahead with the publication of the Bill was the appointment of David Nicholson to be CEO of the National Commissioning Board there has been a powerful tussle going on between centralising and decentralising forces within the NHS reform programme. Over this period the Government’s capacity to implement its reforms has grown weaker and weaker, leaving a power vacuum into which the NCB has walked.

The nascent clinical commissioning groups are beginning to get the fuller force of the authority of the NCB brought to bear on them – and its proving to be an unequal struggle.

So how can a group of local GPs who still do not properly exist as an organisation, empower themselves in such a way as to ensure that they can achieve something locally? This is an even bigger problem because if a group of GPs gains a reputation of wanting to do what they think is best for their local patients rather than what they are told to do by the NCB, they may well find that the process of becoming authorised by the NCB is very hard.

So how does a nascent GP group play this power game?

The leadership of the NHS in the DH have always quite rightly felt that given the size of the NHS they do not really have to pay much attention to other parts of government. So therefore outside of social care, the NHS, at the centre, has never really seen local government as being of any relevance.

At a local level the NHS has had to work with local government and local GPs, whilst they may not have had a structural relationship with local government, recognise that through its services local authorities are important structures.

The one localising part of the Bill that has been maintained and even strengthened during the Government’s great reform retreat has been empowering local authorities through the Health and Well Being Boards. The Conservative part of the Government has seen the empowering of local Government as an easy way of giving something to their Liberal Democrat allies. This has looked like a cost free part of the great retreat.

Across the country shadow boards are being set up that that bring together local health partners with the possible clinical commissioning groups, and they are learning how to think through real partnership working.

Over the next 18 months it will be very much in the interest of local government and the Health and Well Being Boards for their nascent clinical commissioning groups to thrive. If from April 2013 local clinical commissioning groups have not been authorised to carry out local NHS commissioning, then that commissioning will be nationalised through the National Commissioning Board. (NCB)

Under such circumstances there will be no local governance of local NHS commissioning at all.

Local authorities are used to having to battle with all forms of Government to ensure that their localities have any say at all in the development of local services. The fact that they will now have to battle with the NCB to gain any influence over local commissioning will be familiar to them from so many other areas of policy.

What will become clear to local government is that if, from April 2013, they want any influence at all over the local commissioning of NHS services they will need to have an authorised clinical commissioning group on their patch. It is therefore strongly in every local authority’s interest to support their local clinical commissioning groups in developing as organisations and then in gaining authorisation.

I am sure that over the next 18 months, local government will increasingly come to recognise this and support their local GPs. However it would be very helpful if local GPs were to recognise that now. Close links with local government are one of the few power bases into which the NHS NCB will not have inroads. The NCB will not understand local government or the influences on it.

Therefore it is enormously in the interests of clinical commissioning groups, as they receive increasingly strident instructions from the NCB, to be able to say that whilst this may be something that of course the NCB wants, it is not something that their local authority wants.

This could create a new axis of power. One that local government is good at, but the NHS needs to learn. That is the ability to stand up for local needs against an onslaught from the centre.

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 »