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 »

Q. When does the BMA seek to restrict the choices of its independent professional members?

Filed Under (BMA, Clinical Commissioning Groups, GP Commissioning, GPs) by Paul on 22-12-2011

A. When they might chose to do something with which the BMA disagrees.

Over the years the BMA, like any effective trade union, has always stood up for its member’s right to make their own choices. All trades unions do this and the BMA is assisted in this role by the professional autonomy training that all doctors receive.

Whilst this is true of all doctors, it is even truer for GPs because GPs have also traditionally run their own businesses. Therefore, as small business people, it has been up to them where they get their accountancy or legal advice from. Similarly it has been up to GPs to decide whom they might employ as receptionists or nurses. Read the rest of this entry »

Preparing for the Francis Report – Prepare for the next Health and Social Care Bill

Filed Under (Francis Report, Health and Social Care Bill, Secretary of State) by Paul on 21-12-2011

The car crash that is the Government’s policy-making process for NHS reform has somewhat hidden the fact that there is an entirely different policy-making process going on. Constitutionally this has no real relationship with the Government’s process. This is the Francis Report on Mid Staffs.

Make no mistake about it, though this may look like a Public Inquiry into a hospital that let down its public, it is actually an organisation writing the next round of NHS policy. Read the rest of this entry »

During which month next year will the Government start being honest about the myth of protecting NHS resources?

Filed Under (Conservative party, Expenditure, Health Policy) by Paul on 19-12-2011

Regular readers of the blog will not be surprised that I am returning to the problem of the Government’s narrative about the NHS. What story is it trying to tell? Read the rest of this entry »

So what can telehealth and telecare achieve for NHS patients?

Filed Under (Health Improvement, Telecare) by Paul on 15-12-2011

I sometimes feel that there is a conspiracy within the NHS against the implementation of step change. Those who do not want to change the way in which they work are always seeking evidence against the new. They show that the ways in which they do things are the best ways and that there is no evidence for new-fangled ways of working being any good at all. All these new ideas not only don’t save money – but are unsafe as well.

Read the rest of this entry »

Governance and commissioning in localities from now to April 2013.

Filed Under (Clinical Commissioning Groups, Local Government, National Commissioning Board) by Paul on 13-12-2011

Last Wednesday I ran a session with about 60 people in London, all of whom were involved in the governance of NHS commissioning over the next 16 months. As you can imagine, given the confusion around who is commissioning what, there was a broad range of different organisations represented. Most of them were non-executive directors of PCTs, PCT sub-clusters and PCT clusters. This led to much jesting about whether their title would have changed at the end of the meeting from the one they had at the beginning – a whole 2 hours later. (Yes I know – what a sad world I live in where this passes for jest!) Read the rest of this entry »

Can institutions be made to innovate?

Filed Under (Innovation, National Commissioning Board, Regulation) by Paul on 12-12-2011

Last Monday saw the publication of an important DH document on innovation.

The report’s introduction contained – for the first time in a Government document – the difficult truth that the current struggle to save £20 billion is not just the short term development that most in the NHS have assumed. No, this will now become the way in which the NHS has to operate for a much longer time span. Read the rest of this entry »

Remind me Mr Lansley, who started this top down reorganisation which has taken the NHS away from ‘the big picture’?

Filed Under (Reform of the NHS, Secretary of State) by Paul on 08-12-2011

I can understand how impatient the current Secretary of State must be to get the discussion about the nation’s health back to ‘the big picture’ and away, for example, from the detail of who, out of the NCB, Public Health England, the local Health and Well-being boards and the local Clinical Commissioning Groups is actually responsible for commissioning services that will decrease the number of smokers. (The answer being of course, all of them). Read the rest of this entry »

Developing both Health and Well-being Boards and how they work together.

Filed Under (Clinical Commissioning Groups, Health and Well-being Boards, Local Government, National Commissioning Board) by Paul on 07-12-2011

On Monday I spent the afternoon working with representatives of all of the local Public Health and Health and Well-being boards in North West London.

Two interesting issues arose from this experience.

The first was that local authorities across the sub-region are dedicating developmental time and effort to the process of taking on health improvement. They all recognise that to achieve this they will need to develop their Health and Well-being boards as the forum for discussion with clinical commissioning groups. Read the rest of this entry »

Developing the NHS in a long age of austerity

Filed Under (Public Health, Reform of the NHS, Resources) by Paul on 06-12-2011

Last week’s autumn statement underlined all the other economic news and left the nation with the recognition that hard economic times are here to stay for a lot longer than we might have hoped.

Some of the economic statistics about the difference in our living standards in this decade compared with others are really shocking but are worthwhile rehearsing.

Since World War Two the previous decade when living standards took a bit of a knock as compared to others was the 10 years between 1973 and 1983.There were ups and downs during that decade, but taken overall average living standards only increased by 14% over the decade. I say ‘only’ 14% because this was, when compared to every other 10 year period, the most difficult. In every other decade improvement in living standards were higher. Read the rest of this entry »

What direction are GP commissioners taking?

Filed Under (Clinical Commissioning Groups, GP Commissioning, GPs) by Paul on 05-12-2011

I spent last Thursday at the NHS Alliance Conference and heard from GP’s own mouths where they felt they were in terms of taking on NHS commissioning. This is not a random sample of GPs but represents a part of their leadership who want to take up commissioning.

The first thing it’s important to say is how keen nearly all of them are to take on the challenge of commissioning for their patients. Most of the GPs I met understood what this will entail, recognised that it’s going to be difficult and were generally realistic about the task. But they really want to do it. Read the rest of this entry »