Ah, spring time. A time of new beginnings. Daffodils sprouting through the snow. And like hesitant young lambs, looking around at their unpleasantly cold surroundings, the new structures responsible for England’s public health will pop into being this chilly bank holiday weekend. After a marathon of consultations, delays, and clarifications, public health will complete its move out of the NHS and into local authorities.

What does this mean for public health doctors like me? Well—I don’t think anybody really knows yet. But we’re soon going to find out the answers to some of the big questions. Will the director of public health report to the chief executive, or the director of adult social services? How, if at all, will we feed into the new CCGs? And a particularly pressing issue: how much money will public health have, and who will be in control of it? more…

We’ve been having this conversation since at least 1945, said a member of the audience at this week’s Cambridge Health Network meeting on partnerships between the NHS and the private sector. The dominant rhetoric now is that partnership between the NHS and the private sector will be essential for improving health and generating wealth for UK Plc, but down in the bowels of the NHS the feeling is often different.

I’ve experienced that feeling directly by joining a private sector company. For many people I became a monster overnight, moving from being the good guy who was editor of the socially conscious BMJ to somebody who had sold his soul to the devil and was out to destroy the NHS. This narrative, which will follow me beyond the grave, amuses me but upsets my wife. Some old friends don’t talk to me. Many others have experienced the same opprobrium on moving to the “dark side.” It’s seen as betrayal. more…

In an article in the Daily Telegraph, Gerry Robinson tells us that “fixing the NHS is straightforward.” He writes with optimistic alacrity of pragmatic, logistical, data-fuelled managerial devices to sharpen purview and performance. He cites management in McDonalds and Phones4U as good role models for healthcare. He conveys this as if it is bold and new.

I have been a frontline NHS doctor for more than forty years and my view is very different. In the last two decades we have had ever increasing infusions of such management modelling and corporate redesigns, based on what works in commerce and manufacturing industries. The resulting industrialisation of healthcare—and its guidance by the 3Cs: commissioning, competition, and commodification—has led to grievous loss of humane interest, attachments, and vocation in healthcare. The Mid Staffs debacle is one severe and grotesque consequent example. more…

The main focus of the recent Francis report has been on the implications it has on the clinical and economic management of the NHS, but there are many lessons that can be applied to all levels of hospital hierarchy.

Patient centred care is championed across healthcare, and nowhere as much as in complex care wards for older people, such as the one I’m currently placed on. The increasing number of admissions for older people with complex comorbidities and backgrounds means protocols and standardised treatments, although useful, are continuously being adapted for patients’ needs. more…

NHS competition is back in the headlines, apparently the subject of more tension within the coalition: “Lib Dem pressure forces Hunt to rewrite NHS regulations,” and “New rules on competition to be scrapped.”

The background to this is interesting. The Section 75 regulations published earlier this month—which are ostensibly intended to “ensure good procurement practice”—follow considerable consultation with, and lobbying by, the BMA and other unions. While the Health and Social Care Bill was going through parliament, we proposed amendments to the relevant clauses on competition and procurement practice. When the subsequent draft regulations were published for consultation last July we also raised concerns in a detailed response, particularly about the continuing potential for conflicts of interest between commissioners and providers. more…

How could they have behaved like that? It’s inhuman!

Reading the Francis report, I was appalled and shamed by the neglect and lack of care to which patients in the Mid Staffordshire Foundation Trust were subjected. Remembering though, that this was human behaviour, prompted me to wonder at the circumstances that are necessary for so many people who (no doubt) regard themselves as good to behave so badly. more…

All the political parties and those at the top of the NHS see an important role for entrepreneurs in the latest version of the health service. Those labouring within the service are less convinced, and entrepreneurs have great difficulty finding any customers. The NHS Commissioning Board (or CB, as we are learning to call it) is thus organising a series of meetings for entrepreneurs to help them find their way into the maze of the NHS. I was at the first one this week. more…

In January the government announced the establishment of a new service that will be operational in 2014. While this news seems to have gone under the radar so far, I’m confident that every GP in the country will be referring people to this service every week.

The new service is an Independent Assessment and Advisory Service (IAAS) designed to help around 300,000 people a year to stay in work and so avoid becoming trapped on benefits. GPs will be able to refer complex cases of sickness absence to the service in the same way as they can seek specialist healthcare advice for their patients with complex medical problems. more…

The recommendations of the Francis Inquiry cannot simply be implemented. It is a complicated set of proposals that will create new difficulties and challenges for the medical profession. Doctors need to lead the debate on what happens next.

Robert Francis’s lawyerly circumlocution, filling almost 1,800 pages, guarantees that virtually nobody will read the whole report. Are public inquiry chairs paid by the kilogram? But at its core is the powerful concept of professionals adhering to “fundamental standards” to be enshrined in the NHS Constitution and health service regulations and policed by the Care Quality Commission. Crucially, Francis calls for “zero tolerance” of breaches. more…

With little media attention, shadow health secretary Andy Burnham has proposed scrapping clinical commissioning as part of a new round of NHS upheaval if Labour is returned to office.

In a speech at the King’s Fund recently, Burnham tried to portray his ideas as a mere reshuffling of the structures that will be in place this April.

Just like Andrew Lansley in opposition, Burnham said “our fragile NHS has no capacity for further top-down reorganisation… I know that any changes must be delivered through the organisations and structures we inherit.” more…