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…

Substandard care within maternity services remains a high profile issue. It seems that every month there is news coverage about failing hospitals, avoidable maternal deaths, and below optimum care provided to mothers.

Last month the Care Quality Commission (CQC) issued a formal warning to a hospital outside Greater London following three visits in February 2012. They found an increased risk of patient safety being compromised due to staffing levels and failure to complete risk assessment forms. It is not sufficient for maternity teams to just address existing unsafe care, they need to look at risks proactively, and ensure that a rigorous and robust risk management system is in place. more…

Over the last few weeks my reading and listening has made me consider whether we are at a crossroads in understanding and agreeing the purpose and nature of healthcare. Let me start with this quote from the evaluation of the 16 integrated care pilots that were supported by the Department of Health:

“Over the past 50 years healthcare systems have been focusing on strengthening acute care sectors to respond to the needs of patients suffering from life-threatening conditions such as heart attacks. Thus, healthcare systems may not be well equipped to respond to the needs of increasingly older patients suffering from multiple chronic conditions and who require a combination of regular primary care support with both predictable and unpredictable specialist care. The goals of care for those with chronic and/or disabling conditions are not to cure (as is the case for acute conditions), but to enhance functional status, minimise distressing symptoms, and prolong and enhance quality of life through secondary prevention. It is clear that these goals are less likely to be achieved through traditional approaches to care that focus on individual diseases and are based on a relationship between an individual health/social care service-user and a single health/social care professional.” more…

A group of doctors is threatening to stand candidates at the next general election in revenge for the Health and Social Care Bill. The anti-reform medics plan to target at least 50 senior Liberal Democrats and Conservatives with small majorities, running on what Clive Peedell, co-chair of the NHS Consultants’ Association, describes as “the non-party, independent ticket of defending the NHS.”

It would be mere quibbling to point out that 50 candidates standing on a common platform would be a party, not a non-party, nor independent. More salient is that the history of similar movements and independent candidates in general elections offers little encouragement for Dr Peedell and his colleagues. In 1990, a group of GPs established the NHS Supporters Party, with the identical aim of standing 50 parliamentary candidates; the peak of its success was to achieve ninth place in the Mid-Staffordshire by-election of that year, with 102 votes. more…

The political ambiguity is, mostly, resolved. Very shortly, appointments will be made to Clinical Commissioning Groups (CCGs). At the same time appointments will be made to the local arm of the NHS Commissioning Board (now to be known as the “Area”), the NHS Commissioning Board Sectors (formally known as SHA Clusters), and Commissioning Support services. What was theoretical is becoming something very tangible. 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 very beginning” has famously been advocated as “a very good place to start,” but when it comes to sustainability, this doesn’t seem to be such an easy mantra to follow. For one thing, it’s not altogether clear where “the very beginning” is, and for a second, we in the NHS are so busy trying to keep up with the here and now, that hunting around to find the ideal starting place seems out of the question.

Well, here is an altogether easier and more accessible approach—let’s start at the NHS sustainability day audit… NHS sustainability day is coming up on the 28 March, and there are a whole host of reasons why this is a good opportunity for anyone who works in the health service to get involved. more…

Action on climate change is good for our health, good for our wealth, and good for our environment—our life-support system.

We are all complicit in the degradation on our once-reliable, stable climate. The climate science is clear. The economic arguments are clear. And the health message is clear: we can all do things that impact—for good and for ill. more…