Posts Tagged '#Brexit'

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.

 

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Election focus: The General Election and Brexit – diversion, divisions and tactics

In the next piece in our election focus series, Janice Morphet looks at the impact of the general Election’s delay to Brexit negotiations, questions that aren’t being answered, how each party are approaching Brexit in their campaigns and the significance of tactical voting.

Janice Morphet

As the General Election campaign moves on, it appears to be characterised more by pauses than progression.

We now have the EU ready to start negotiating in a serious manner while foghorn diplomacy is all they meet across the channel. Since the Prime Minister took office, there has been a wasted period when the electorate has been lulled into assuming that these negotiations will be easy while the EU has been consistent about its position and the issues.

The EU finds it hard to deal with shocks but thrives on process. Once it could appoint its negotiators and set out its red lines it became stronger and more confident and this would have occurred whoever it faced in number 10.

Continue reading ‘Election focus: The General Election and Brexit – diversion, divisions and tactics’

Election focus: how can the Left re-engage the people?

simon-winlow

Simon Winlow

In the second of our blog pieces focusing on the fast-approaching General Election, Simon Winlow, co-author of The rise of the right asks how it can be that, against a background of social, financial and environmental catastrophe, a political party dedicated to the neoliberalism seem set to secure a large majority. How can the Left get the people on side again?

There’s a terrible air of nihilism, cynicism and acceptance about the upcoming election. The Conservatives have made huge gains in the local council elections, and UKIP and Labour have lost quite badly. Of course, the general election could be very different. More people will vote, and the local issues that can sway council elections tend to be forgotten as the big issues of the day take precedence.

Theresa May has clearly timed the election to take advantage of disarray in the Labour Party, and in the hope carrying a large mandate into the upcoming Brexit negotiations. Pollsters are predicting a landslide for the Tory party, with UKIP disappearing as an electoral force and Labour continuing its slide toward oblivion.

Continue reading ‘Election focus: how can the Left re-engage the people?’

Election focus: Housing policy predictions & radical solutions

In the run up to the General Election we will be bringing you insightful pieces from our authors on policy-relevant subjects, including housing, health, welfare and, underpinning it all, increasing social inequality.

Let’s look beneath the distraction of Brexit and Labour’s disarray and examine the issues we really need to be thinking about as we put our cross in the box on the 8th June.

DB pic

Duncan Bowie

In this piece, Duncan Bowie, author of Radical solutions to the housing supply crisis looks at what housing policies may be included in the party manifestos and explains the radical solutions we need.

“The focus on Brexit and the negotiations on withdrawal from the European Union has meant that housing has not, at least as yet, become the key issue in the election campaign that perhaps would have been expected had the referendum not taken place.

Debates so far have focused far too much on the contrast between Theresa May’s advocacy of ‘strong and stable leadership’ and whether or not the Labour Party leader is fit to be Prime Minister or the divided Labour Party is ‘fit to govern’. There has been little focus on policy issues, though (at the time of writing), the main party manifestos have not been published.

The political parties, including the Conservatives, were all caught on the hop by the election announcement and consequently the drafting of the various electoral offers have been somewhat of a rushed process. Even a matter of weeks before the election was called, Labour housing spokespersons were reluctant to make any policy statements policy on the basis that it would be premature to give commitments before 2020, even though housing was bound to be a key issue in the local and city region Mayor elections, which were scheduled. Labour was even hesitant to commit to repealing the 2016 Housing and Planning Act, despite the fact they had opposed it in parliament.

Continue reading ‘Election focus: Housing policy predictions & radical solutions’

Family migration: Re-uniting across international borders

Why have so many Polish families chosen to make the UK their home? In this blog post, Anne White discusses some of the motivations for and complexities of family migration to the UK, as explored in her book, Polish families and migration since EU accession, out today in paperback. 

Anne White

British society has been changed beyond recognition by the recent influx of people from Central and Eastern Europe, and particularly from Poland.

To everyone’s surprise, within a few years Poles have become the largest group of foreign nationals and the largest foreign-born population in the UK. The evidence suggests that many Polish people now consider themselves settled in Britain, at least for the medium term.

The fact that so many Poles are with their families does a great deal to explain why they feel at home in the UK, even if just ten years ago parents shared the general ‘wait and see’, ‘let’s give it a go’ attitude of the tens of thousands of other young Poles who experimented with migration to the West around the time their country joined the EU.

How did it happen?

The Brexit campaign centred on the slogan of ‘taking back control over our borders’, but migration research has demonstrated time and time again that controlling immigration in a democracy is an unrealisable ambition. As Castles and Miller (2009) famously observed, immigration cannot simply be ‘turned on and off like a tap’.

Continue reading ‘Family migration: Re-uniting across international borders’

#EUfightback: staying hopeful and determined for a continent united in diversity

In the wake of the triggering of Article 50, Dimitris Ballas, Danny Dorling and Benjamin Hennig, co-authors of The human atlas of Europe, find hope in the diversity that unites the European Union. 

Dimitris Ballas

Danny Dorling

Benjamin Hennig

 

 

 

 

 

 

 

The result of last year’s referendum on the EU membership of the United Kingdom was massively and decisively influenced by false promises and lies, including the pledge of £350m per week for the NHS, the promise that Britain would remain in the single market and the misleading claims that immigration was to blame for the pressure on social services rather than the underfunding of public services.

In fact, migrants contribute disproportionately more to the provision of health, social and educational services than they use those services.

Continue reading ‘#EUfightback: staying hopeful and determined for a continent united in diversity’

Article 50: where we are now

Janice Morphet, author of Beyond Brexit, looks at what the future holds for the U.K. after the triggering of Article 50 and the formal beginning of the Brexit process. 

Janice Morphet

As the UK government faces its two-year roller coaster ride of negotiation, following the Prime Minister’s triggering of Article 50, many pressure points have already been revealed while some remain as haunting unknowns.

The first challenge that has emerged is how ill prepared the UK government finds itself. While the letter triggering Article 50 and the subsequent White Paper on the Great Reform Bill are full of words addressing internal political party agendas, any pretence of maintaining a united view across the UK has been abandoned.

No legal basis for devolution

Although stating in the White Paper that everything would remain the same until dismantled and changed through Parliamentary procedure, this is completely undermined in the chapter on devolution which confirmed the re-centralisation of returned powers on agriculture, environment and some transport issues.

Subsidiarity is based on principles laid down in the Treaty on European Union and there are no guarantees that it will survive Brexit as a principle of the UK state. Following Brexit all devolution within the UK, including to cities in England, will transfer to the whim of each five-year Westminster Parliament and cannot be agreed in perpetuity.

Continue reading ‘Article 50: where we are now’


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