Reform of the the House of Lords has been rumbling along for many years. Started by Tony Blair’s Labour Government, it was in the manifesto of all three main parties during the last general election, and it formed a lynchpin of the coalition arrangement between the Conservative and Liberal Democrat parties. Nick Clegg is personally championing the current plans for reform, submitted as a draft bill in May 2011. more…

Ch,ch,changes. The next couple of months are going to see a sea change in the management of commissioning across England. The appointments to the NHS Commissioning Board (NHSCB) sectors are being made. Appointing to these four posts will allow the wave of appointments to the local offices, to be renamed as local area teams, to be made. The commissioning support services are passing through “checkpoint two” and being set up to receive large numbers of staff from PCT clusters. more…

We are working through trying to understand exactly how commissioning support (CSS) will work with Clinical Commissioning Groups (CCGs). At a recent time out the lead manager for the CSS presented on the progress being made with Greater East Midlands CSS (GEM). They highlighted the scale of work that is required with the 277 tasks in the development plan. One of the Chief Operating Officers presented the programme of work required to see through the transition from a CCG. As they pointed out, this was a transition plan—for which the work required for authorisation is a component, not the be all and end all. There is as much to do to develop the CCGs as there is to develop the CSS—and they are mutually dependent. more…

The prime reason that this legislation will prove a disaster for patients is obvious. If you are relying on the NHS for care it is your GP who will be the sole arbiter of the care you receive, and most importantly will control the funding for any referral to secondary care. GPs will not be obliged to accept any guidance from secondary care specialists. The funding that GPs will receive will be inadequate for the tasks in hand when economic conditions are difficult. Therefore it will fall to GPs to be very circumspect about which patients actually get referred to secondary care. A friend of mine rang me recently and told me that she had type 2 diabetes, uncontrolled hypertension, and hypercholesterolaemia. She had requested referral to a diabetes specialist, but this had been refused several times. This was before the bill became law. If this lady could afford to pay for private care directly or by insurance, she would be referred without question. She cannot afford to do either. She is doomed to receive second rate healthcare, and this will be enshrined in the debacle of which Andrew Lansley is the architect. If you can pay you will get the care you require, when you need it and where you need it. more…

It is all over now. The Health and Social Care Bill has been passed. The politicians have moved on, content to leave professionals and managers to pick up the pieces. Whichever side of this exhausting, divisive, and passionate argument you favoured, we are in a different place now. It is no longer a question of should we or shouldn’t we? Instead it is: how do we make this radically different NHS work for our patients? And how do we avoid reasonable fears about the bill from becoming a reality? more…

Monday to Friday, for weeks now, there has been a teleconference bringing together the leads from all the major organisations across Lincolnshire involved in health and social care. The ambulance and community services, acute and mental health plus adult social care, are all regularly represented. The meeting is chaired by a commissioner. The purpose is to share intelligence and efforts to support patient flow. We started this way of working last winter and it has resulted in more “jaw jaw” and less blame shifting,  as different contributors to the  system, all of whom are dedicated to patient care, appreciated the problems other organisations were struggling with and how they could help each other. more…

The reforms grind on. In the stratosphere there is a lot of noise and turbulence—people arguing passionately and polemically. Meanwhile the architecture of a new system is being constructed around those of us working in the old system. People are wondering where their future lies, or if they have a future. The basic construct is becoming clearer to many of us and we are working to support its creation. This is driven by the desire to ensure that the good work done for the public and the patients in the past does not get lost in the transition between systems, and to try and secure the theoretical benefits of the new system. It is also to try and mitigate the unintended consequences, which might not be so beneficial. more…

Watching Andrew Lansley at the Nuffield Trust Summit last week was to watch a man surprisingly at ease. The Health Secretary is at the centre of a huge media storm, surrounding an enormously mangled bill, decried by all and sundry in the medical profession and beyond.

But he started his talk with a joke, he hung around for questions (which he answered directly if a little technically), and at the very moment the Lords were figuratively dismembering his offspring, he seemed a man unexpectedly relaxed. more…

David Cameron and Andrew Lansley assert that a large majority of GPs support their bill. Is it true? Where is the evidence? Is the profession lined up in willing support, eager to take on responsibility for managing the NHS through its greatest crisis? Perhaps we all took the King’s Shilling while in our cups in the taverns and only now are waking up to find ourselves press-ganged aboard a merchantman across uncharted seas in the government’s service. more…

We are now constantly discussing the transition process and the programme of work we have mapped, which we need to follow to deliver the structural changes demanded by the reforms. This sits alongside the planning process, with the plan for 2012/13 shuttling back and forth between the SHA, PCT cluster, Clinical Commissioning Groups (CCGs), various key providers and Health and Well-Being Board. Then there are the contract negotiations, which people who have been involved will know, have a degree of all-consuming intensity at this time of year. more…