Archive for the 'Health' Category

Election focus: Avoiding Another Failed NHS Experiment

In the next post in our Election Focus series, David Hunter, author of The health debate, explains that the election must not become an excuse for shelving much needed health system transformation.

David Hunter

“A possible unwanted side effect of this most avoidable of unnecessary general elections, and the accompanying purdah into which everyone has slumped, is the impact on the NHS reforms initiated by the NHS Five Year Forward View published in 2014 and its update in the Next Steps delivery plan published last month.

One can only hope the NHS Chief Executive, Simon Stevens, is correct when he asserts that ‘there is no version of reality’ in which his changes will not be needed and actively pursued. Even if he is proved right there could still be disruption if a new health secretary replaces the current post-holder, Jeremy Hunt.

Or if the all-consuming Brexit negotiations divert the government’s focus and slow down the pace of change as seems likely. Or if a new administration decides to replace Stevens. As the chief architect and champion of the changes, he is critical to their success, especially at such a delicate stage in their evolution and before they have been fully embedded.

New Care Models and Sustainability and Transformation Plans

The election comes at a pivotal time in regard to progress with the New Care Models (NCM) nested in the Vanguards initiative and the evolving Sustainability and Transformation Plans (or Programmes if you prefer) (STPs) agenda.

“…opens up the prospect of further stalemate and a failure once again to get to grips with long overdue changes to reshape the NHS for the new challenges it faces.”

In the case of STPs, Labour has stepped back from its rather foolish pledge announced in the leaked manifesto to impose an immediate moratorium on them if elected. But while the final manifesto now states that Labour will merely ‘halt and review’ STPs, the move still heralds a return to heavy-handed ministerial meddling from the centre.

As a way of running the NHS, it has rarely if ever been desirable or worked. Moreover, it opens up the prospect of further stalemate and risks failing once again to get to grips with long overdue changes to reshape the NHS for the urgent and complex challenges it faces.

What’s needed?

For the changes to succeed requires sensible resourcing and sustained commitment over a reasonable time period, both of which are already fragile under the current government. If re-elected with a larger majority it is unlikely much will change which could leave the changes in a precarious state, especially when coupled with the desperate pressures the NHS is already under both in terms of financing and staff recruitment.

So, while perhaps not putting the changes at risk in the way Labour’s proposals seem destined to do, a Conservative government with a fresh mandate need not axiomatically be good news for the NHS.

If the political outlook for the NHS changes presently being implemented looks potentially bleak or risky whoever wins, it will be incumbent on senior managers and clinicians, perhaps with the support of the Royal Colleges and others, including local government, to lead and drive the changes.

An opportunity

The Vanguards and STPs represent a chance of a lifetime opportunity to transform the NHS as it approaches its 70th birthday in July 2018. Too often in the past resistance to change has won out and the result has been an NHS which in many respects has become ossified and no longer fit for purpose given the changes in demography, lifestyles and the evidence of growing inequalities.

“Too often in the past resistance to change has won out.”

Successive inquiries and critiques of the NHS have pointed to the repeated failure to take prevention and public health seriously, to integrate health and social care, and to rebalance the health system away from costly, acute hospital care. The Vanguards initiative and STPs are confronting head-on all these deep-seated systemic problems that have persisted in the NHS for decades.

Drawing conclusions from the NCMs is premature and inconclusive. Generalising from very complex and different models and contexts is a hazardous business. But, putting these health warnings to one side, the early evidence emerging shows a passion, enthusiasm and high level of commitment to make the changes work. They are also felt to be the right way to go in terms of patient care.

Once the evidence from the local evaluations starts to appear later this year, there will almost certainly be a mix of likely successes and failures although it will take longer to assess how far the changes have actually impacted on health outcomes. It is also the case that, as the Public Accounts Committee concluded recently, STPs are a mixed bag and of variable quality. In most places, engaging local government and the public should have assumed a much higher priority at an earlier stage.

But when all is said and done, the unprecedented transformation journey on which the NHS has embarked has given permission to local areas to chart their own destinies within a national framework providing support and development know-how. It is not perfect and tendencies for old-style, command-and control behaviour to surface have to be resisted. Nor is the overall financial climate helpful or sustainable although, if one is honest, resource pressures have been an important stimulus for change.

If the changes underway can be maintained post-election and the NHS becomes a genuine health service rather than a sickness one, which it has been since its inception, then that must be the goal of all those who want the NHS to survive and should be embraced enthusiastically.

Warts and all, we should not squander this opportunity to transform the NHS so it can meet the 21st century challenges confronting it. Surely that has to be a 70th birthday present to remember.

 

The health debate by David J. Hunter is currently available with 50% discount on the Policy Press website.  Order here for just £7.49.

Browse all the books in our 50% General Election promotion here.

Find out more about impact, influence and engagement at Policy Press here.

Policy Press newsletter subscribers receive a 35% discount – sign up here.

The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

Care and caring: challenge, crisis or opportunity?

SusanMYeandle

Sue Yeandle

As the first issue of the International Journal of Care and Caring publishes, Sue Yeandle, Editor-in-Chief, highlights the global space that care now occupies and introduces the journal as a new forum where world-class knowledge about care, caring and carers can be shared.

Issue 1 of the International Journal of Care and Caring is free to access on Ingenta until 30 April.

“From Nairobi to Tokyo, Sydney to Bogota, Montreal to Stockholm and Gdansk to Glasgow – and beyond – care is more visible than ever, and an issue of growing importance all over the world. It is central to human life and relations. It underpins the world’s health, employment and welfare systems. It affects every family and human being on the planet.

“In all its horror, glory and daily realities, care touches us at every level.”

Continue reading ‘Care and caring: challenge, crisis or opportunity?’

Blinded by science: when biology meets policy

Sue White and David Wastell, authors of Blinded by science out today, explain the rise of neuroscience and genetics and their influence and impact on social policy.

David Wastell

Sue White

“Biological sciences, particularly neuroscience and genomics, are currently in the ascent. These new ‘techno-sciences’ are increasingly seen to promise a theory of everything in the psychosocial realm.

Social policy has not been slow to conscript technological biology, and is making significant use of neuroscientific evidence to support particular claims about both the soaring potentialities and irreversible vulnerabilities of early childhood, and the proper responses of the state.

The far reaching implications of epigenetics

The last decades have also seen a profound shift in our understanding of biological processes and life itself.

Whereas genetics has conventionally focused on examining the DNA sequence (the genotype), the burgeoning field of epigenetics examines additional mechanisms for modifying gene expression in manifest behaviours, physical features, health status and so on (the phenotype).

It provides a conduit mediating the interaction of the environment on an otherwise immutable DNA blueprint, and invites a natural interest in the impact of adverse conditions, such as deprivation or ‘suboptimal’ parenting. The implications of this for social policy are far reaching.

Continue reading ‘Blinded by science: when biology meets policy’

It’s not just about the money: 5 dilemmas underpinning health and social care reform

Following on from the publication of the third edition of Understanding health and social care, Jon Glasby looks at what’s needed for long-term, successful health and social care reform.

jon-glasby-pic-2

Jon Glasby

Open any national newspaper or turn on the news and (Trump and Brexit aside) there is likely to be coverage of the intense pressures facing the NHS.

Throughout the winter, there have been stories of hospitals at breaking point, an ambulance service struggling to cope, major problems in general practice and significant financial challenges.

For many commentators, this is one of the significant crises the NHS has faced for many years, and quite possibly the longest period of sustained disinvestment in its history.

“Draconian funding cuts have decimated services at the very time that need is increasing.”

Continue reading ‘It’s not just about the money: 5 dilemmas underpinning health and social care reform’

Get social care right and the NHS will benefit

How can we improve access to and quality of social care? Catherine Needham, co-author of Micro-enterprise and personalisation, discusses how micro-enterprises and micro providers could improve care services. 

catherine-needham-head-shot-b

Catherine Needham

At a time when the Red Cross is warning of a ‘Humanitarian Crisis’ in the NHS, there is a growing recognition that pressure on NHS services will not be alleviated unless we get social care right.

Social care services support frail older people and people with disabilities. They are run by local government and have borne the brunt of the local authority cuts in recent years, with around 26 per cent fewer people now getting help than did in the past.

Many care providers have gone bust due to downward pressures on fees and in many parts of the country it is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.

“It is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.”

Together these pressures contribute to older people being stuck in hospitals, unable to be discharged into the community because the support is not available to them.

Fixing social care

Getting social care right is not a quick fix. Access to good quality, affordable care for people with disabilities and older people is a challenging issue.

Continue reading ‘Get social care right and the NHS will benefit’

Where you live can kill you

Clare Bambra’s book Health Divides: where you live can kill you, published by Policy Press today reveals shocking facts about the social, environmental, economic and political causes of these health inequalities. In today’s guest blog Bambra shares her insights on how location really is a matter of life and death…

Clare Bambra

Clare Bambra

In 1842, the English social reformer Edwin Chadwick documented a 30-year discrepancy between the life expectancy of men in the poorest social classes and the gentry.

He also found a North-South health divide with people from all social classes faring better in the rural South than in the industrial North.

Today, these inequalities persist.People in the most affluent areas of the United Kingdom, such as Kensington and Chelsea, can expect to live 14 years longer than that those in the poorest areas, such as Glasgow or Blackpool.

Men and women in the North of England will, on average die 2 years earlier than those in the South. Scottish people also suffer a health penalty with the highest mortality rates in Western Europe. Continue reading ‘Where you live can kill you’

10 things you should know about foodbanks

hunger-pains-fc-4webThink you know about foodbanks and the people who use them? Think again.

Kayleigh Garthwaite’s book , Hunger Pains, challenges some of the biggest foodbank myths.

Here are the top 10…

1. Anyone can turn up and get a food parcel

You need a red voucher to get food, given to you by a frontline care professional who has identified you as being in need. It is likely that many people in food poverty who are outside of the ‘system’ aren’t getting help.

If somebody does come in and say “Can I have some food?” you can say “Have you got a voucher?” as that’s the rules.” Foodbank volunteer

Continue reading ’10 things you should know about foodbanks’


Enter your email address to follow this blog and receive notifications of new posts by email.

Twitter Updates

Archives


Helen Kara

Writing and research

Peter Beresford's Blog

Musings on a Mad World

Paul Cairney: Politics & Public Policy

Professor of Politics and Public Policy, University of Stirling

Path to the Possible

Democracy toward the Horizon

The GOVERNANCE blog

Governance: An international journal of policy, administration and institutions

Shot by both sides

The blog of Kerry McCarthy, Labour MP

Paul Collins's Running Blog

Running and London Marathon 2013 Training

Bristol Civic Leadership Project

A collaborative project on change in local governance

Stuck on Social Work

And what a great place to be

Points: The Blog of the Alcohol & Drugs History Society

short and insightful writing about a long and complex history

Urban policy and practice

Publishing with a purpose

TessaCoombes

Policy Politics Place

Blog

Publishing with a purpose

Public Administration Review

Public Administration Review is a professional journal dedicated to advancing theory and practice in public administration.

Publishing with a purpose

%d bloggers like this: