Jeremy Ambache attended the Adult Care and Health Overview and Scrutiny Committee on 8th June 2010. Jeremy reported that the second phase of the Mental Health project was agreed and on his suggestion, Health Care/ NHS will be added to the Corporate Business Plan with regard to the development of Safeguarding. Jeremy also asked whether there are any plans for the Drug Action Team to work with poly-systems, he was told that at present there is no explicit agreement to work with GPs and poly-systems in the Drug Action Team Plan. It was also decided at the meeting that the plan to improve Information services was agreed and a further report will come back: this includes the Careline contract ceasing at the end of September, but a continued service in-house in the immediate term.

Come along to Wandsworth LINk’s next open meeting on 19^th July 2010, 6 p.m at the Platt Centre Putney,  the subject of the meeting will be PERSONAL BUDGETS.

Carol Barton, Wandsworth Council’s Transformation Programme Manager will be at the meeting and this is the perfect opportunity to have your questions answered, we want our members and local people to determine what Carol talks about, not the other way around. To ensure that this happens we’re asking that, if possible, you submit your questions to us before the meeting, especially if you can’t make the meeting but still have opinions you want expressed, and questions you want answered.

Liberating the NHS the new Health White Paper on “equity and excellence” could turn out to be, in Chris Ham’s prophetic words today, the “biggest organisational upheaval in the health service, probably, since its inception”.  This is about England only of course: the contrast with the other three countries in these islands will now be even starker.

Shaping the new order

Speaking in the Commons this afternoon as the document was published, Secretary of State for Health Andrew Lansley said his objectives were putting patients right at the heart of their care, putting clinicians at the heart of decisions about services and achieving health outcomes comparable of our neighbours.

We are to have an outcomes framework identifying what the health service should achieve and it will be up to the professionals (in collaboration with the public and patients if Lansley is serious about “no decision about me without me”) to say how it should be achieved in each part of the country.

Some of the other highlights of the new order include:

• A payments system that acts as a driver for quality, safety and integrated care not just a reward for activity (very welcome)
• Decision making as close to patients a possible, including patients with long term conditions having budgets (we hope for health AND social care combined) to make real choices about their care.
• Real, local accountability: Local Authorities will agree local strategies to integrate NHS, public health and social care together.  (fine, assuming councillors rise to the challenge and there isn’t likely to be extra money for cash-strapped authorities)
• Consortia will commission NHS services in line with the local health plan agreed with the local Council; this is how GPs will lead bottom up redesign of services:“GPs are senior professionals in public service and paid well for that.” No opting out.
• Patient choice over treatment options, including the consultant-led team that treats them, based on a torrent of information to guide informed choices
• Choice of GP practice and  power to control our own patient records. (no practice boundaries)
• Patient voices will be heard and acted upon by Healthwatch as a national body working through local healthwatch incorporating the current LINks (across health and social care which is essential)
• An English NHS “liberated from command and control”, including all NHS Trusts to be Foundation Trusts with power in the hands of their employees and users: “Our ambition is to create the largest and most vibrant social enterprise sector in the world.” (could help with getting assets off the government’s balance sheet and sort the pensions issue too)
• Any willing provider in the health care marketplace, provided they deliver to NHS standards and prices
• A more powerful Monitor as economic regulator and CQC as the guardian of safety and quality standards
• The NHS Commissioning Board holding the national GP contract, managing performance, allocating resources to commissioning consortia and leading specialised commissioning (big job all of that, any applicants on the horizon?)

Liberation is a double edged sword

MAC’s initial reaction to all of this – our deeper thoughts are for later –  is that what Mr Lansley is proposing  - and the devil will be in the detail of the coming consultations and the autumn Health Bill – could certainly be “liberating” both in an innovative but also in a chaotic sense (think Pandora’s box)  - and probably at the same time.  The phrase “constructive discomfort” comes to mind.

But there’s a catch. The NHS in England must save recurrently some £20bn by 2014 - “every penny saved will be a penny reinvested for the benefit of patient care” Mr Lansley said. That takes many steady eyes and hands on the job and some well placed voices are wondering if now is the right time to pursue wholesale root and branch change which will be very distracting in our largest and most expensive public service? Managers fashioning lifeboats for themselves may have concerns other than achieving efficiency savings.

Cromwellian thoroughness and speed

The reforms to commissioning and accountability aim to be Cromwellian in thoroughness and speed.  Andrew Lansley seems to be taking Tony Blair’s approach further and faster than anyone thought possible, but the difference is there seems to be a map this time.  Our modern day “major generals” (aka Strategic Health Authorities)  are being marched off to the Tower awaiting termination  - or as Mr Lansley termed it “disempowerment of bureaucracies” – by 2012, to be followed by PCTs by April 2013.

As we move towards then, will the crowd be shouting “behold the heads of tyrants” as we breath the free and pure air of GP commissioning, or will we just be too distracted to care?  And will there be anyone left in PCT land by then to turn off the lights, cancel the milk and put the cat out?

2 Comments

Filed under Foundation Trusts, Local Involvement Network, Management & Innovation, NHS, News posts, Public Involvement, Social Care, commissioning, social enterprise
Tags:

Comments

2 Responses to “Liberation root and branch style”

Caroline Millar says: July 13, 2010 at 10:19 amI have real concerns about GP commissioning not relieved in any way by watching the debate on Newsnight yesterday where the panel of around ten people contained no-one who represented the patient voice – although of course several GPs who were utterly convinced that they knew better than anyone what patients needed and wanted. We have to stop this persistent conflation of what GPs think is good for their patients with what patients themselves want. They are not necessarily the same thing. How do GPs know what patients want/think/experience? How many GP practices have patient groups – and where they exist do they make a difference? Every time you ask patients what they want they come back with the same issues. Two of the biggest issues are evening opening and rude receptionists yet somehow nothing ever seems to get done about these particular wants. So with the GPs in charge will patients necessarily be better off than they are now? It certainly is by no means a foregone conclusion!Peter Westland says: July 13, 2010 at 2:25 pmwell it is early days but it would be nice to know whether they mean “commissioning” or “procurement” and at what level in this “new” two tier arrangement the “commissioning” will be done….ie the analysis, horizon scanning, planning services for the future3. This will no doubt be placed with the “top” brainbox end of a consortium…with people imported from PCT’s and SHA’s OR that lot will be abandoned in favour of intellectuals from the USA or even Price Waterhouse. Whatever…it will look a bit like a PCT except it will not have the usual governance by retired captains of industry, accountants and estate agents….or will it. Also I can’t make out how the accountability will work. And Finally …Public Health to Local Authorities….some of us have argued for this for 20 years…but how will this now relate to the new NHS. Plenty of work for you Andrew and colleagues….

July 19th LINk Executive Meeting

Not just valuable but vital

Only to be dismissed at once when at a recent training we did for Wandsworth NHS we met active and interested older volunteers who were a strong reminder of the value of this resource. As people often tasked to set up user panels as well as train them, we readily acknowledge that many a participative venture would collapse without the time, energy and ideas that the older involved and retired citizen brings to the table. Is the prospect of working beyond the current pensionable age a threat to this resource? We say no so long as we get the flexibility in the labour market that encourages part-time working. The new volunteer in this context would have a wider set of choices between paid and unpaid work which may well enhance the chances of their participation and at the same time increase the value of that contribution because they remain connected to the wider world through their paid work.

Eight New Laws of LINks

Certainly when we look at any form of future development for LINks, no progress would be possible without good quality people being ready and able to serve on and contribute to them. The elder community will remain an important pool of recruits. Andrew was very gung ho about LINks in his piece. He wrote that LINks must not only survive but take on a more robust role. To that end, he promulgates eight news laws for LINks – essential reading for policy makers we would say.

Reorganisation – flavour of the month

Reorganisation – how fast, how far, how good – crops up in almost everyone of our blogs. Caroline Millar writes 12 years as a parent have provided many an example of how change gets sneaked through in the summer. Leading the charge for change in education, is the new Secretary of State for Education. Glinting in the sunshine of his new powers like the granite of his native Aberdeen, Mr Gove is granite-hard in his resolve to create Academies asap. In doing so he seems very ready to dump any commitment to consultation in his rush to deliver. He is of course ready to consult later when all the important stuff has got done. Why are citizens cynical about consultation do I hear you ask?

Trust the Teachers and GPs

Having identified bureaucracy as the enemy of local change, local authorities in education and PCTs in health are being bypassed in favour of teacher and doctor power. Parents are also being urged to get involved in schools but the knowledge that entry to ‘their’ school will probably be by lottery so their own children may not get in, is a bit of a bummer. However as graduates of the consumer movement in a number of its manifestations, three MAC partners have a superstitious reverence for the power of Young and so cannot dismiss entirely the chances of success for y0ung Young channelling his dad’s influence from beyond the grave to create a new school in West London. (It is an article of faith for all consumerists and others in the field of social policy generally that ‘Michael Young later Lord Young of Dartington was the greatest British social entrepreneur of the second half of the 20th century’. Discuss using one side of the paper only).

GPs working within consortia are going to be the new commissioners of health and social care services. We have two immediate concerns. The first is the very uneven record of GPs in setting up effective and credible patient participation bodies. Secondly, our work with commissioners of long term and not so long term neurological conditions makes us very wary about GPs being able to take on this complex and often neglected area of clinical and social care practice. Andrew discusses his reservations in a head to head with Lynn Young of the RCN which you can get a link to here.

More substantively, his piece Neuro Knees Up or Knockback? raises important questions on how best the Third Sector and in particular neurological organisations can safeguard what we know is a considerable investment in making the best of the commissioning system in place now. Reform threatens to waste this effort and set back their work in improving care for people with neurological conditions.

Colin Adamson

The Moore Adamson Craig Partnership LLP

Blog: http://www.publicinvolvement.org.uk/

Email: colin@mooreadamsoncraig.co.uk

Voice: 020 8670 0595 / 07785 552167

For more information please call 020 8812 7794 or freephone 0800 389 7921

Or visit www.smokefreewandsworth.nhs.uk

Or email stopsmoking.team@wpct.nhs.uk

Since the smoking ban on 1 July 2007, Wandsworth Stop Smoking Service has supported 3,880 smokers to quit, which means a lot more people who are:

• Enjoying better health

• Saving money on cigarettes or tobacco

• Protecting the health of their family

• Looking better, smelling fresher

• Free from the routine of smoking

SmokeFree legislation, which was introduced on the 1 July 2007, means smoking inside any premises or communal areas such as stairwells and balconies, other than your home, is not permitted. This includes areas designated by your employer that are outside but where smoking is not permitted (check the smokefree policy on staff room for details). While this has motivated some people to quit, evidence shows that you are four times more likely to quit with help from NHS stop smoking services.

An appointment takes just 15* minutes, so come in at a time convenient to you – taking the first step is easy and we will support you the rest of the way.

Ready to quit? Thinking about it? Need to try? Talk to us today.

*First appointments take 30 minutes

The week is not just about encouraging more men to take part in sport – there are many other ways of staying healthy. Men should try to find easy and enjoyable ways to fit more physical activity into their daily routine – from cycling instead of taking the bus, swimming at lunchtime or finally sorting out that garden! If men can start getting active, whilst eating at least five portions of fruit and vegetables a day they can halve the risk of getting serious long-term diseases like heart disease, high blood pressure, and several types of cancer.

Here are our top 10 ways to live a healthier lifestyle:

• Get more active

• Eat five portions of fruit and vegetables every day

• Stop smoking

• Have all your jabs

• Maintain a healthy weight

• Wear a condom

• Be safe in the sun

• Cut back on your alcohol intake

• Recognise stress and try to manage it

• Enjoy yourself

By following this simple advice you can stay healthy, improve your well being and live longer. To find out more about ways of getting active and staying healthy just go to www.wandsworth.nhs.uk

“Hospital discharge was chosen as one of Wandsworth LINK’s four priorities. The Enter and View Team wished to discover more about how patients and their carers experience the discharge process. We intend later to follow the patients into the community to assess the quality and appropriateness of their care and support at home which will help to inform our opinions about the Transformation Agenda-another of the LINk’s priorities. We planned a visit to St George’s Hospital to seek the opinions and views of the patients who were being discharged and their carers.

We wanted to find out how the policies work on the ground on the day of discharge. Particularly seeking to establish whether the discharge was safe and how the patients and their carers felt about the process….”

Community Partners is a project of Wandsworth Care Alliance working actively with service users, patients and carers, providing training so that participants can help shape more responsive social care and health services.

Community Partners has now teamed up with the Neurological Team at NHS Wandsworth, to offer training for a group of people using the long term neurological conditions services and/or their carers.

The training will cover these areas:

Day one:         Information gathering: ways to find out from a wider body of people living with and caring for people with neuro conditions about what needs to change

Day two:          Specialist nursing: finding out how specialist nursing currently operates and starting to work with the specialist nurses towards change

Day three:       Communicating about the conditions: service users and carers have repeatedly said how little their condition is understood by agencies and staff.  Day three will be about producing a video for health and social care staff to learn what they need to know if they are to provide effective respite and other services.

The training will be held at the Randall Close Day Centre in Battersea, a fully accessible venue, on Monday 22 and 29 June, and Monday 6 July, 10.30am to 3.30pm.

If you would like to take part, please contact (by post, email or phone): 

Susan Wheeler-Kiley

Wandsworth Care Alliance

89 Bickersteth Road, SW17 9SH

Phone: 020 8516 7768

freechoice@wandcareall.org.uk

You can also contact Susan if you have questions or just want to find out more.

The service is available for carers looking after an adult living in Wandsworth.

It means that the person cared for would be properly supported if the carer was involved in an emergency and unable to look after them.

Carers can meet with The Carers Emergency Support Service Worker and then develop an emergency plan.

To arrange an appointment to develop an emergency plan please contact 020 8877 1200.

After registration carers will receive an Emergency Pack with an Emergency Card included.