Sir Stephen Bubb

Sir Stephen Bubb

Thursday, 26 May 2011

Doctors and other such

I did some joint commissioning last night with my friend ( well she is till she reads my report! ) the President of the Royal College of GPs, fiesty Clare Gerada.

We had both been at a dinner at Deloitte for doctors and ACEVO members and as we both live in Lambeth we decided to get a cab home. I mused on whether we should do a procurement exercise and stop 3 taxis and see what offered the lowest price, but in the end we went for spot purchasing and as I live in brixton and Clare in Kennington she got a free ride. Is that cherry picking I wondered?

The dinner, and session before was excellent. ACEVO is undertaking a review with ippr on how the third sector relates to GPs. There has been concern amongst members that GPs are not acquainted with the full scope of the sector. Our role in delivery as well as advocacy and advice, research and volunteering and community development.

We had a lively discussion. Clare herself is well up on the sector- indeed does work with Victor's Turning Point. We are going to develop work in ACEVO on this which will help develop the new consortia commissioning process.

But during the day we held a strategic awayday for the Adventure Capital Fund, which I chair and which invests in community enterprise. We had presentations from 2 of our investees; a company in N Yorkshire " Chopsticks" that produces woodchips and kindling for the community but working with an intrepid band of young people who could not get jobs elsewhere due to their disabilities . It is highly successful. Then a community school in Liverpool , Lister steps, which looks after kids from 2 to 12. It has a review of its social impact by New economics which showed for every £ they spent there was added value in the local community at £46. And yet they are struggling. Practically no support from the council , who have to implement major cuts anyway.

Get a text from old friend Gordon Marsden MP who says he met Obama yesterday and had a chat! Was I jealous. And I noticed Michelle Obama was at my old Oxford College , Christ Church with her bunch of aspiring school kids. Those were definitely the hot tickets of the day!

Tuesday, 24 May 2011

Back From Serbia, forward with the Future ( and Big society )

Arrived back on Saturday laden with bottles of wine , including a generous gift from the Crown Prince Alexander of a fine wine from his Royal vineyards. I was received at the Palace on Friday and had my own tour with the Head of the Privy council. Then onto a reception with Her Britannic Majesty's Ambassador, Michael Davenport. Biljana gave me a dawn tour of the Belgrade fortress and churches ( including a bottle of holy water for the flight).




At the Royal Palace with my work shadow Biljana


With head of the Privy Council


But if I thought I'd get a quiet Sunday I was sadly mistaken. I did the Murnaghan show on Sky with Francis Maude and Hazel Blears on , Big Society. I was there as a sort of sage to comment on the political spat between the 2 of them. I was able to draw attention to some of the important recommendations in the Rennard Commission on Big Society. Mother thought I needed a hair cut and my tie was not fully adjacent to collar!




Read the Rennard Commission report here.

Monday dawned and while my colleague Dr Peter Kyle was rushing for milton Keynes to the "relaunch" of big Society I was off to a full meeting of the Future Forum.



Peter on Sky alongside Fraser Nelson, Editor of the Spectator, talking Big Society and cuts

A good and productive day. My Panel had an excellent session. We have consensus ( well so far anyway ) on our key recommendations. A superb discussion covering really contentious issues but we will have a good report which I believe will help move us forward in the debate on choice and competition. By concentrating on how we promote citizens rights to choice we can put the competition issue in proper context. One of the problems of the debate has been to see competiton as some sort of ideological goal as opposed to a way of widening choice through a diversity of providers like charities and social enterprises.

I see some press hatter around getting rid of the " any qualified provider" provisions. Given that many , if not the majority of such are third sector I find this idea not just silly but insulting to the great work we are doing in the health and social care field. Is anyone going to tell me that when the majority of people at the end of life die in a hospital bed, yet want to die at home or in a hospice we are going to limit the work of charities rather than expand them? There will be no return to " preferred provider". It is wrong in principle and wrong in practice.

Friday, 20 May 2011

The work continues....

The streets were bussling, the pavement cafes loud with the chatter of the evening crowds and the restaurants full to overflowing as Belgrade goes about its business of enjoying itself.

But a sad figure sits in his hotel room , pouring over drafts and suggestions pouring in from London, working on the health report.

I doubt you feel sympathy!

Today I should be in London for a meeting in No 10 to meet with the PM to discuss an update on our findings. But I've been signed up to be a keynote speaker at a major gathering of the third sector clan of Serbia and I wanted to keep my commitment. And why have a Panel of eminent persons to support you if you can't delegate. So I have. Paul Farmer of MIND is one of the giants of our sector and he will do me proud!

Now I'm at that major gathering . I make a keynote speech on the importance of civil society in building strong democracy. I link the role of the sector in delivering services like health and education and campaigning and advocacy. In Serbia there is a small but growing role for civil society organisations in delivering services - I spoke to the local government Minister about just this. But there is still a crucial role in trying to build a more stable democracy. Much of civil society here has its origins in citizens bonding together to fight dictatorship and as anti war campaigners. A noble history.

Euclid is going to work with the leaders of CSOs to help develop leadership. We are also involved in an exciting social finance initiative to develop loans to help build a more sustainable sector.



Filippo Addarii, Executive Director, Euclid Network


Biljana Dakic, my work shadow on right

Thursday, 19 May 2011

Escape to Serbia

I grabbed my Euclid Secretary - General hat and fled for Heathrow! Asidious readers of the Blog will recall I'm doing a work shadow exchange with a top Serbian ngo leader Biljana Dakic-Djordjevic spent a week with me in London trailing around Whitehall etc. I was supposed to do a week of shadowing her but I'm afraid the Health work intervened. But I was determined to fulfil at least part of my obligation and so I'm here, blogging from Belgrade.

Arriving late I was wisked off to a stunning resyteraunt in central Belgrade- sititng under the plane trees and listening to the violinist it was easy to see why " mittel europe " is so charming. A fine dinner and excellent Serbian white wine from the Royal estates. So relaxing to talk about things other than health; war crimes, human rights , peace ands such like.

But obviously I can't escape completely and I do changes to the report on the plane following lots of emails from my colleague panel members. The plane journey proves most fruitful.

So first thing its off to see Milan Markovic, The Minster of local government, human and minority rights- oh and he also has responsibility in thre south of Serbia handling many issues around Albanian and Serb relations. A young, dynamic guy who is clearly influential in Governmnt. He also had a hand in framing the new law on civil society and we talked about the newly established Government Office of civil society.

It was then off to see Grupa 484, set up in 1995 originally to support refugees fleeing from war in Croatia. There were 484 families who were the original people supported. Now much extended , the also do research and work with Government on refugee and migrant policy. A great organisation- set up as a visionary idea by a famous prima ballerina and peace activist Jalana Santic. Its a marvellous example of the power of our sector to achieve change.

So now I'm at this lovely restaurant in a small tree lined courtyard in Old town Belgrade withMiljenko Derta, the Director of Civic Initiatives and Miodrag Shrestha. We are relaxing in the sun. See us here.

Wednesday, 18 May 2011

Acronym Heaven

I'm deep in CIOF and QUIP and trying hard not to be submerged. I think there is a machine in the basement of the Department of Health where they insert policy papers and out comes an acronym.

It’s hard not to get sucked into using all this DH speak and yesterday I was at a meeting with the Dementia Alliance and Clare Gerada, the great president of the Royal College of GPs, took me to task for talking about integrated care pathways.

She said patients are not parcels to be pushed along pathways. She is right. I went back to remove these from my draft.

It is interesting how the health service uses language that excluded and often patronises. Hence "patients". The majority of people managing long term conditions are simply folk, citizens who want support in how they handle their condition. They are not patients.

At a brilliant listening session with the Health Foundation someone from a "patients group" made the point that, on average, someone with Type 2 diabetes has 7 hours contact time with doctors and nurses in a year. The rest of the 365 days they get on with managing their condition (or not).

So those new converts to "integration" (you don't actually need a Bill to do it, so why the hell hasn't the medical establishment sorted this by now instead of thinking it is a clever ploy to counter competition?).

The Dementia Alliance pointed out that one in four of people in hospital beds have dementia. An appalling statistic. But it illustrates the perverse incentives in our current system. It is the same with people who at the end of their life are denied the chance of dying at home. Time to stop focusing on hospitals and look at where the budget is spent. I may have made this point before!

This is a fascinating process. I meet some incredible people. Have been to some great meetings (and some not so great; the one with Unite was not perhaps a highlight).
And so interesting to hear the Clegg speech. Seems he may have some idea about what we are proposing. But be nice if the politicians could perhaps pause before jumping the gun on what I shall be saying. I'm optimistic the report will make a real contribution to better reform. It’s worth the sleepless nights and hassle.

But I do need to put more pen to paper. And this is an historic process for me. For the very first time I composed and sent my civil service minder a "PDF". Of course this was hardly useful as it was pointed out you can't edit a PDF. So I managed to send it as a word document. I've even managed the magic of cut and paste. But my colleagues back at ACEVO be warned: This is not an excuse to remove my PA.

Monday, 16 May 2011

Health , the Big Society

Cameron is right. Ed Miliband is right. We need to " change and modernise the NHS...to make it more efficient and effective and, above all , more focused on prevention, on health not just sickness. We save the NHS by changing it ". ( PM today ).

Could not agree more. It will be the core theme of the Report I'm now working on with my Panel on choice and competition. I'm beginning to see some consensus emerging.

As my old friend Jill Dixon , CEO of the Nuffield Foundation said this morning on Today we need competition but also cooperation. And Stephen Dorrell MP , writing in the Times says one of the crucial issues facing us is how to merge health and social care.

I'm pleased we seem to be getting agreement around the need to focus on the issue of long term conditions and the ageing population. A new approach is needed. Not based on a medical model n but on integrated care, focused around the individual and with a major role being played by the third sector.

A conference call with my colleague Chairs on the Future Forum at 9 pm last night! We agree that we will be able to produce Reports that move this debate forward and will make recommendations for change that will both improve th Health Bill and point the future direction for health and social care.

Having spent most of the weekend drafting, and re drafting, swapping points and wording with my colleague Panel members my head is spinning. But I can see the key points emerging. We will say competition is important. But we will also say the perception of privatisation has to be tackled by changes to the Bill. And we will argue strong for commissioning that promotes diversity of providers, like our third sector , cooperation across providers wherever they are , and integrated care packages. And all this focused on choice and citizen empowerment.

And now I'm blogging from Church House where we have the launch of the Rennard Bigsoc Commission. A gathering of the great and the good from sector and beyond.




A rather excellent report in the Indi on Sunday gives a good summary of it and so I reproduce it here.

" A hard-hitting report into the scheme by an independent cross-party commission will say that the Government's enthusiasm for it risks being undermined by "over-rapid and poorly managed public spending cuts" to the voluntary sector, particularly in low-income areas.

And a YouGov poll carried out for the commission, chaired by the Liberal Democrat peer Lord Rennard, found that 78 per cent of the public believe the PM and Government have failed to articulate what the term actually means.

The report says this failure to tell a "sufficiently compelling narrative" has "fuelled high levels of cynicism" about the motives behind it at a time of swingeing public spending cuts.

Because of this vagueness, the agenda risks being used by Whitehall and local authorities as a "cover for cuts", the authors argue. The commission panel includes Mr Cameron's former policy adviser turned Conservative MP, Nick Boles, as well as the Bishop of London, the Rt Rev Richard Chartres, and charity chiefs.

A separate ComRes poll for The Independent on Sunday shows that in fact fewer people understand what the term "Big Society" means now than three months ago: 40 per cent admit they could not grasp the concept, compared with 30 per cent in February.

Mr Cameron launched his vision for the Big Society, the brainchild of his strategy chief Steve Hilton, in November 2009. After becoming Prime Minister a year ago, he said his government's reform agenda would have the Big Society at its heart.

But since then, some cabinet ministers have been indifferent to the project, with the Liberal Democrats under Nick Clegg virtually disowning the notion altogether.

To revitalise the idea, Mr Cameron will publish the Giving White Paper, designed to boost charitable donations, at the same time as meeting social enterprise award winners, selected by the Big Society Network, at an event in Downing Street a week tomorrow. The event is being held on the eve of the US President's visit. Mr Hilton's original idea was inspired by President Obama's own community volunteer programme, and Downing Street hopes that their visitor will see echoes of his own scheme.

Critics have warned that, while the Big Society "brand" has fuelled a flurry of innovative social enterprises, it masks the closure of, and cuts to, less glamorous voluntary schemes that rely on local government grants.

The commission's report says the growth of the Big Society should not be matched by a reduction in the size of the state, or moves by the Government to "abdicate its responsibilities, particularly with regard to the most vulnerable". Voluntary sector grants from local authorities are down 56 per cent year on year in some areas, which "contravenes the objectives of the Big Society", the report warns.

It highlights the inverse relationship between volunteering rates and levels of deprivation, with graduates twice as likely to volunteer as those with no qualifications.

It warns: "Not only does community capacity to deliver the Big Society vary, the variation is likely to be exacerbated by cuts. The capacity of individuals to contribute to their communities is likely to be more dependent on the state supporting them to do so."




Dame Clare Tickell, CEO of Action for Children with Lord Rennard



Lord Boateng, Nick Boles MP, Dame Clare Tickell


Dame Clare Tickell was superb. Talking about the role of Action for Children , formed in 1869 , she said they have often has to " step in , where the State has stepped out". She warned that it is the most vulnerable and the most deprived areas that have the lowest levels of volunteering and is suffering most from cuts. She said attacks from government supporters on big charities risk alienating the very people they need to support them.

Nick Boles , the conservative MP said local councils and key prime contractors must accept their duty to deliver effective services and Government must set boundaries. They must set a high expectation they use the third sector more.

Lord Paul Boateng gave an impassioned speech for more community activism.

Saturday, 14 May 2011

It's back!

Yes , the missing post is back. Now you can read " Competition is not a disease ". I suspect dear Sir Robin had a word with his old chums at MI5 and told them not to pay any attention to all those folk at DH trying to censor me. Thank you Robin. Or was it your friend Sir Bumble Heep?

Friday, 13 May 2011

Whither Big Society?

Have you noticed? Where has Big Society gone?

This week marks the first anniversary of the coalition. They produced a paper listing all their achievements. But the term Bigsoc was strangely absent. ThePM writes major article for the Mail on Sunday. Again no mention of Bigsoc. And we are one year on from the launch of it all in No 10.

ACEVO launches the Commission on Big Society on Monday. A Commission chaired by Lord Rennard , with illustrious members like that magnificent prelate my Lord Bishop of London , lord Paul Boateng, Dame Clare Tickell ,Nick Boles MP amongst others. It's message is that this was a policy that was poorly articulated and poorly communicated , but that at root is an important statement of the power of citizens and communities. It criticises business for failing to get behind the concept. It argues that the banks and financial bodies have largely failed communities by refusing to loan or back the third sector. It says we need a Community Reinvestment Act and a levy on the banks profits to go to charity. Of course banks are large supporters of charity. Bit the Report urges them to do more.

The Report from the Commission has called on the government to give people paid time off work to voulnteer in their community. Currently employees have the right to take time away from work for certain public duties, such as serving as a magistrate or on the governing body of a school so we are calling on the government to extend the Employment Rights Act to include voluntary work, to help bring about the prime minister’s vision.

A poll, conducted by YouGov for the commission, showed that 9% of employed adults in Britain said they would be very likely to apply for paid time off to do voluntary work, while 28% said they would be fairly likely — together equivalent to 10.8m people.The poll also found that 66% of British adults believe business leaders should do more for the communities they serve, for example by donating more of their profits or allowing staff to use paid time to take part in a volunteer project.

The poll also found that 74% backed demands that the Banks give 1% of their profits to charity. That is one of the key recommendations in the Report.

At heart , the concept of empowering more citizens and redrawing the boundaries amd relationships between state , civil society and citizens is one well worth supporting. This concept lies at the heart of the big society idea,and why public service reform is essential.
So what are we to read into the sudden silence on Big Society? What are we to make of the strange disappearance of the White Paper on public service reform. The " pause " on health service reform has allowed the opponents of reform in health a field day to oppose further opening up of the NHS to charity and social enterprise provision.

Significantly 78% of those polled said that the Government have failed to give a clear vision of Big Society.

There is a rather interesting comparison with the health reforms here. In both cases the Government have poorly articulated their vision and communicated it badly. The result is that both policies now seem to be on hold. We now need the Government to rearticulate the vision of a bigger, stronger society. One that marks a partnership between state . Citizen and our remarkable third sector.

What is going on?

I suspect the worst. Blogger suddenly goes down after my last post on the Forum. And the post , which appears briefly , is now nowhere to be seen. I'm asking Sir Robin Bogg to establish an independent review. We need to determine whether the Department of Health , in cohoots with MI5, have sabotaged this. I know they were not happy at me sneaking out to speak to Today , but this is a bit extreme isn't it?

Facts and the DWP!

I was astonished to hear the interview with IDS on the Today programme when he was "" announcing " some yoof initiatives on Thursday. He said that the FJF had only created jobs in the private sector. . He went on to compound his error by claiming that young people crashed out of work after the scheme ended.

Unbelievable.. The third sector was closely involved in job creation for young people on this great scheme. And many remain in jobs now.

. The FJF had an independent evaluation built into the scheme from the start. The incoming government couldn't wait for this to inform their ill thought through decision to scrap the scheme. Then they scrapped the evaluation. A shame , as this would have established whether this was effective or not.

So let me reproduce the letter to IDS from ACEVO ' s acting CEO.

" Dear Secretary of State,

After listening to your appearance on Radio 4’s Today programme this morning, I thought it worth dropping you a quick note. I was concerned by the following comment:

“The Future Jobs Scheme created only jobs in the public sector and once the money ended those poor young people crashed out of work straight away”

I urge you in future when speaking about the Future Jobs Scheme to acknowledge the vital role of the voluntary sector and to avoid giving the impression that it was solely a scheme aimed at the public sector. This would be a great disservice to the hundreds of organisations who supported thousands of potentially vulnerable people via the scheme. I realise that your own commitment to voluntary action means that a diservice of this kind is the last thing you would want to perpetuate.

In truth, the Future Jobs Fund enabled the placement of long-term unemployed young people in both the voluntary and local government sector’s. I cannot comment on the effectiveness of placements into the public sector, but I can for the voluntary sector which responded with alacrity. The sector was involved in developing the policy, organised into consortia to ensure widespread distribution of placements, and relished the opportunity to use the initiative to offer a rich, challenging, and educative experience. And, of course, such placements into the voluntary sector not only tackled the challenge of youth unemployment and skills development, but also contributed towards positive social change as a result of the extra capacity enabled within voluntary organisations.

The scale of the voluntary sector response was also considerable. One consortia alone, 3SC, which was established from within the charitable sector in order to deliver placements, supported over 5,600 youngsters into work. As you know we do not have any comprehensive evaluation of just how many of the 6 month placements were either extended at no cost to the tax payer, or how many were converted into full-time jobs, but my members do have considerable anecdotal evidence that both occurred in abundance.

I realise that the Future Jobs Scheme is a political ‘hot potato’. However, I feel obliged to point out that within the voluntary sector it has been widely perceived as a success in delivering vital vocational skills to potentially vulnerable people whilst unlocking potential within non-governmental organisations. This does not mean that the scheme, or successor schemes, cannot be made more efficient or effective as patently with cooperation between government and the other sectors we could make improvements based on our experience."

A polite response in the circumstances frankly.

And as youth unemployment continues to rise they must be deeply regretting their decision to junk FJF because it was introduced by the last lot.

The suggestion that rising youth unemployment is the fault of the last government is ludicrous. They have been in power a year. And our economy is at a halt. Is there a connection between a stagnating economy and rising youth unemployment do you think? And I'm puzzled quite why the Government are going to rely on the private sector to create more jobs for yoof. Has anyone noticed that commercial companies are laying off staff, not hiring them.

Third sector shut out? What is going on in DWP ? Mind you , I feel sorry for IDS. He has a strong feeling and strong support for our sector. What on earth was in his briefing.
 
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Thursday, 12 May 2011

" Competition is not a disease "

The thing about doing the Radio 4 Today programme ( and how I love that show ) is that not only do I have to get up at unearthly hour but I spend the night in involuntary rehearsal of my answers to potential questions ( most of which do not come up ). But I listen to it in the evening and I sound coherent and even vaguely authoritative. I think I may have given the poor old press lot in DH a sleepless night too. They just so hate having an unguided missile on their decks ! But I'm jealously guarding my independence and that means I shall continue to speak out on health reform. There are strong professional vested interests who want no change , and think competition is not relevant. I know that public service reform is vital and have not spent a decade arguing for radical shifts towards third sector service delivery to be thwarted by those interests. As the Times headline put it. " Competition is not a disease ".

Clare Gerada , President of the Royal College of GPs rings me afterwards to say well done and to assure me their position is in favour of charity provision of services. A nice call. We swap horror stories on the Press. The Times carry an article from me on how competition is essential in driving choice in long term conditions and for end of life care. And let me tell you I was writing that article till 1.30 in the morning on Monday.

I have been to so many meetings in the last few days I have little time to think. I'm supposed to be writing the report. It's true I've done the first few pages, but that's hardly the full month. And yesterday we had a full day of the Future Forum. To say this was testing would be an understatement. I had produced what I had thought was a helpful paper with a framework and ideas for the Report. This did not prove an obstacle to my Panel discussing what they wanted to discuss, aided by those who hadn't actually read it anyway. And then we had helpful facilitation which frankly did not enhance the process as far as I could tell. Still , I left with lots of ideas. Quite whether I can pull this together I muse over in a hot soak later that evening , having ditched further meetings in the interests of sanity.

But I can hardly complain. This is the most contentious of issues. People are passionate about them.

I managed a peek at the pitch..





There was an interesting divergence on the issue of openness or confidentiality. I'm always wary of the coercion of groups. This tends towards uneasy consensus and the hiding of genuine differences. I feel that open discussion on the issues before us is right. It is why I continue to Blog and to express opinions. When I took on the role I said I must be free to speak out, otherwise independence is trammelled. And that applies to those who take divergent views from me.

Monday, 9 May 2011

Queen Mary, Doctors and martyrs

On Sunday I was doing a Queen Mary! Every year, in May, Queen Mary would visit the glorious American garden in Dulwich Park to see the stunning rhodedendrons. And yesterday I did the same; the Hound and I entering the park through Queen Mary Gate! Here are the views:







And as I viewed the gardens I was talking to a Doctor ( as I seem to do frequently these days! ). Steven Laitner is a GP and clinical advisor to the DH. He is a strong advocate of a radical new approach to long term conditions, much along the lines I have been advocating so we had a good chat. We both agreed we have to move away from a medical model of tackling the growing problem of long term conditions.

He has sent me a paper he developed for the East of England strategic health authority. It advocates what it describes as " integrating Pathway Hubs ". Essentially the hub would be the prime vendor for the provision of health and care services needed for say, people with diabetes. It would gather together a range of contractors across the third sector, the private sector , doctors and hospitals but with the emphasis on health and care largely controlled by the individual and in the community.

Later on I get a fascinating note from one of the members of my choice and competition panel , Anthony Mckeever , Bexley Care Trust. I think the point he makes is worth repeating here;

" You suggest that "Long term conditions take 75% of the NHS budget". I know just what you mean - and I think it is a fundamentally important point. But it is actually worse than that. The lion's share of every commissioner's budget actually goes on acute services (though it shouldn't). This is because the system behaves perversely locking itself into spending on institutions rather than services. Figures show that - despite policies intended to shift resources to primary and community care settings - the proportion of total NHS spending on acute services has consistently increased under successive Governments.....

They undertook an analysis of Bexley residents in terms of health spend and,


" It turns out that 0.5% of our residents accounted for about 20% of our total expenditure (I.e. the people with multi system disease and probably chronic conditions towards the end of life). Furthermore, 5% of our residents accounted for around 66% of total spend. "

Astonishing! No wonder we need to move to prevention and a citizen centred approach to health management.

Sunday ends with a teleconference call with the 5 of us panel chairs. We have become a jolly bunch - united in adversity! We reflect on the latest political musings; its clear we are handling one hot potato. But we are optimistic we can come up with a report that helps move the debate forward.

Yesterday was also the Sunday set aside to remember the Martyrs of the English reformation. I said Mass for the repose of the soul of my ancestor Sir Edward Neville who was beheaded by Henry V111 for his adherence to the faith; my Great Grandfather x13 he was the last of my ancestors to be knighted. I also have another ancestor , the Rev Thomas Somerville ( descended from Edward ) who was evicted from his living for refusing to swear allegiance to the Hanoverians as he had sworn his oath to the Stewart James 11. A pesky lot eh!

I like to think an anti establishment gene runs deep in the Bubb DNA. It probably accounts for my reaction to all the helpful notes I get from civil servants with "templates" , "formats" and , would you believe. " a protocol for blogs"( you can tell where that one went can't you! ) ! Mind you, I can't blame them. My staff have tried similar in the past ! We shall see when I produce the report on choice and competition. I've written the opening paragraphs. As for the rest we will see what emerges from my Panel discussion when we get together on the football pitch. The opening is good...just not sure what the end looks like yet!

Saturday, 7 May 2011

The Big Society and football pitches

An interesting week ahead. Next week marks the first anniversary of the launch of the " Big Society " initiative. So ACEVO will be launching the Report of it's Big Society Commission a week on Monday , the 16th May. The Commission has been chaired by Lord Rennard , with such luminaries as the Bishop of London, Nick Boles MP , Phil Collins, Lord Paul Boateng and Dame Clare Tickell. it will be an exposition of what civil society itself thinks of the notion of Big Society.

The government have been lamentable in explaining what the notion actually means. This report will attempt a better explanation. It will be critical .but it will do so in a positive way.

If you are interested the event is 10.30 at Church House in Westminster.

And next week also see the second meeting of the NHS Future Forum, this time in a football stadium in outer London, facilitated by Cap Gemini. It will all be most interesting. Will they have us out on the pitch for some bonding I wonder ? I fear the worst. I have been to one of those Cap Gemini facilitated events. Dynamic young men leaping around with felt tips drawing pictures of what we are saying! I have been clear. I shall be chairing my Panel Sessions. Without a felt tip and flip chart or spotty youth facilitating me? But I must be positive. Who knows, I might enjoy it? Mustn't be such an old fogey.

I had a teleconference call of my panel on Friday . Conference calls are a tad frustrating and have their amusing side when we were interrupted by the airport announcements as my friend Charles Alessi valiantly tried to take part. We agreed there are some key areas of enquiry. First the main issue of how competition aids choice and whether the Bill amounts to privatisation. It has to be recognised there is considerable concern on this. The Any Answers programme today illustrated this. We had Douglas Alexander and Shirley Williams honing in on how this will lead to private sector takeover and an " American style health service " . We shall need to address this. And we will undoubtedly need to make some changes in the Bill.

We will also need to look at the role of Monitor , unhelpfully named the " economic regulator. ". How should it act. Old fashioned procurement body ever obsessed by rule books , or progressive supporter of choice and protector of the consumer.

Then there is the role of the new NHS Commissioning Board. Will this simply replicate the top down , highly centralised DH model of current unloved memory , or will it promote innovation , diversity of providers, integration and cooperation. Will it continue to think the world revolves around hospitals or focus it's attention on where the money is spent ; long term conditions and elder care?

And finally how will we ensure more choice and consumer power, personal budgets and customer centred care? My view is we must now build into the Bill some external challenge and that is an area me and my colleagues will explore on the football pitch. Come to think of it , much of the debate on commissioning focus on level playing fields so how appropriate is that!

Friday, 6 May 2011

Future Forum- open events

The Future Forum are arranging meetings in every region of the country in conjunction with Regional Voices.

These listening events are for patients, service users and voluntary and community sector leaders to have their say in the listening exercise.

Dates are as follows:

North East 9th May 1-3pm
North West 23rd May 10:30-12:30
Yorkshire & Humber 13th May 10-12:30
East Midlands 18th May 10-12
West Midlands 16th May 10-1
East 13th May 10-12:15
London 13th May 2-4
South East 25th May 1-4
South West 26th May 11-1

To find out more or to book a place click here

Thursday, 5 May 2011

Dog buying not leg chopping

Follow the money. Long term conditions take 75% of the NHS budget. 18m people have one long term condition. Many have more. If you are over 60 it is likely you have a long term condition. If over 85 you will likely have more than one. And the numbers of elderly continue to rise. And the numbers of long term conditions rise. So where coronary heart disease and cancer would once carry you off , they now often represent a long term condition.

So if I were looking at reform and how our NHS will survive on limited budgets and rising demand I would start here.

But we are not.

Why is this?

One reason is the pre dominance of hospitals in all the debates. The medical model is paramount and yet we know perfectly well what works; integrated models of health and social care.

Let's take an example; diabetes; 2,5 million people. And growing. How does the NHS tackle this? At one level, for Diabetes type 1 it's good. It chops off peoples legs effectively and efficiently. Does it do well in work to prevent obesity? No. Does it do well in working with people who have diabetes type 2 to prevent progression ? No.

And how do we commission services? We prioritise leg cutting when dog buying or kite flying may be the way forward. So we need to be working with organisations like Diabetes UK encouraging them through commissioning to develop integrated systems of care for those with diabetes where they work with the private sector ( eg high street opticians ) local government ,other providers of support services in the third sector and hospitals and GPs to develop the integrated offer or offers.

Offers that build in control and choice for the citizen so that they can be more in charge of their condition.

Offers that develop personal budgets for thr consumer?

Already on the ground there are innovative integrated approaches being developed. They are led by organisations like BTCV ( the conservation volunteer body ), MIND , Diabetes UK, Natural England etc which are developing ways to support people with diabetes to get more exercise , support and advice. Why is the DH not promoting and encouraging all this from the front?

So how , in the futue , will the NHS Commissioning Board promote this? A number of pointers are already emerging.

Appointments to the Board should reflect where the money is spent. So over half might come from social care,long term conditions for example . So all the usual suspects from the acute world need to give way.

There needs to be a strong element of external challenge to established DH thinking in appointments. Brendan Barber for example rather than yet another CEO of a large teaching hospital , Barbara Young, Clare Fox of the Ideas Institute, Matthew Taylor. Allison Ogden- Newton. Just to name a few.

In many other organisations that are looking to cut the cost base and increase productivity you would start with where your biggest spend is. But not in the DH. The attention and focus on hospital spend is very noticeable. Many of the comments on competition have been around the effect on hospitals, not on how competition might open up new solutions in long term care or promote integrated care approaches and personal budgets.

I've just emerged from No 10 and another breakfast meeting: though this time it's a bacon roll in the cafe rather than one of those grand roundtable affairs in the State rooms. I push the message above with force but I'm under no illusion that as far as many in the health world are concerned these are the cinderella services. But I'm convinced this is a top priority for health.




The " Pause Room " at DH. My attic abode!

Wednesday, 4 May 2011

Lordly musings

The listening train is moving on. This time stopping to listen to a group of Lords who have an interest in health and will play a key role in debating the Bill. An informed and useful event; helping clarify some of my own thinking.
Time is now pressing. I'm talking to my " choice and competition"panel colleagues on Friday and we have a Forum meeting on the 11th. By the 11 th I want to test emerging ideas and potential solutions. My Report ( and I have made clear to the civil servants supporting us that I am mainly writing it myself: I'm keeping control of the commanding heights of the vocabulary ; I've seen all those Yes Minister episodes! ) will need to be ready by penultimate week of May for delivery to PM by end of the month .

There has been a little too much emphasis on "Listen" as though it were a consultation or that we have blank sheets of paper or blank minds ; and not enough on "reflect and improve ". That means the sooner we start debating what changes are needed in the Bill the better.

I'm also reflecting on my own experiences of getting close and personal with the Department of Health! When this is over I intend to write about that. And I shall have some lovely tales to tell. Good and bad that is!

But on one thing I'm clear: reform is needed. Choice ( and I'm not just talking shopping) is very limited in our NHS. It must be widened.

Customers are not valued or encouraged in a way that has become normal in other parts of the public service. Citizens are recategorised as patients and patronised.

When 75% of the total budget goes on long term conditions that provides a big clue to where change is needed. How does the NHS tackle long term conditions? Badly.

Despite the big clue on " follow the money" the DH and NHS family more generally are consumed by what goes on in hospitals. Acute care is top of the pecking order. Time for change there.

I make these points at a Kings Fund breakfast this morning. I was told by the minders back at the ranch to just stand there and say " we listened". As I thought this was both disingenuous and disrespectful of the audience I was a little more forthcoming.

One thing was clear; competition has a role to play as a means of securing better health outcomes and to encourage the building of integrated health and social care provision across sectors. But it is a means to an end, not an end itself .

Tuesday, 3 May 2011

Challenging the health professionals

Many of our great charities and social enterprises have been borne out of frustration with established ways of doing things or rejecting the professional approach in favour of championing the consumer. In mental health and in learning disabilities or disabilities generally ; parents , carers or citizens have come together and fought for better ways of delivering services and champing the voice of the consumer and citizen. This is important in the current work of reflecting on the Bill.

Let me give you a brilliant example of what I mean.

In 1938, Judy Fryd noticed that her young daughter Felicity was not using language as fluently as her peers, but searched in vain for help and advice. Felicity was rejected from her primary school after only half a day for being disruptive. Within 24 hours of her arriving at a school for children with Down’s syndrom, Felicity’s parents received a telegram from the school that said “Felicity not suitable. Must be removed at once.” At the age of 12 she was institutionalised in a psychiatric hospital. Felicity was described by a doctor as “a child with no mind” - today we would recognise her condition as autism. The way her daughter was treated, the prejudice she came across, and her family’s powerlessness against it, led Judy Fryd to channel her anger through the letters page of Nursery World magazine. Within a month more than a thousand parents had been in touch, and a group of parents in a similar situation banded together with Fryd to form the Association of Parents of Backward Children (now Mencap) in an effort to confront the way their children were treated. Today Mencap is a significant force in supporting people with learning difficulties to live independent, fulfilling lives, providing nurseries, training colleges for around 250 students, support with employment to almost 5,000 people, helplines accessed approximately 33,000 times a year and a wide variety of other services. It has a proud history of campaigns which have significantly changed the law regarding the treatment of people with learning disabilities and their families, such as the 1971 Education (Handicapped Children) Act, which sought to ensure that children with learning disabilities received an education, their having previously been considered ‘ineducable’. Thanks in no small part to the way Judy Fryd and other parents banded together, and thanks to the service provision and campaigning of the charity they formed as a vehicle to do so, the powerlessness and poor services Judy Fryd and her family faced in the 1940s and 50s are significantly reduced today – even if Mencap and other charities continue to face, and struggle against, significant challenges for people with learning disabilities.

This is the power that our third sector brings to the work of the health service. It needs encouraging and expanding. Commissioning needs to ensure organisations like Mencap grow Unless the reforms of the current Bill provide for a major expansion of our sector they will have failed to deliver patient empowerment and better health outcomes.

Wedding celebrations and good governance!

Well, that was a weekend!

Ubi Caritas et amor, Deus ibi est.

Where charity and love are to be found, God is there.

One of the many highlights of Friday was the anthem composed by Paul Melor, celebrating the role of " charity". Sometimes the Latin " caritas" is translated in modern editions of the Bible as love. But the combined scholars working on the 1611 translation of the Bible ( my parents have given me a 400th anniversary copy of the original ) decided charity was the correct translation as it demonstrated that love has to have an expression in actions taken to demonstrate it. This was a time when charity was enjoying a renaissance following the 1601 Statute of Elizabeth defining charitable uses.

And the anthem was rather better than that old fogeyish Crown Imperial and the somewhat sugary Rutter.




My sister Lucy had a prime spot outside the Abbey and even saw Ed Milliband MP in his finery- a sight that the BBC strangely denied us!

We all rounded off the day at a street party in Orchard Rise , Richmond where my brother lives. As it's not far from the house of my Vice Chair Allison Ogden-Newton we grabbed her from her barbeque and with her fantastic family took them along!







Now in terms of good governance it's important not to show favouritism between the Vice Chair and the Chair so come Sunday my partner and I were off to deepest Harrow for lunch chez Lesley -Anne. And she had even rounded up a Peer of the realm to join us ( Lord Low of Dalston and his wife ! ).

We arrived with Hound who caused mayhem. First he got into a fight with lesley-Anne's dog Croxley and when bored with that shot upstairs in hot pursuit of a cat! Good job I haven't got an appraisal too soon.






Monday saw the reopening of my local windmill in Brixton. A notable occasion so I had my sister Lucy and friends John and Allison over.

Brixton Windmill, built in 1816, reopened to the public after receiving a restoration grant from the Heritage Lottery Fund. An afternoon of fun with an irish and a steel band. Our local MP Chuka did the cutting of the red ribbon. And the whole occasion was blessed by ACEVO with both my Vice chair Allison ( a former Brixton resident ) and my Director of Strategy Seb and his fiancee Lucy Stephens.




And a whole weekend not thinking about health service reform !

The coming vote

I get a message from my good friend in Australia about the Alternative Vote. I think I'm allowed to blog it!

"Dear friends in the UK,
 
with the referendum for the Alternative Vote coming up soon I feel compelled to write to you as that's the system they have here in Australia. And it doesn't work and I would really and strongly warn you against voting for it.
 
It's not that I like the current first past the post system either - I don't - it's just that changing it to the preferential voting system (or AV as they call it in UK) is a further step AWAY from democracy and transparency, not towards it.
 
This is the voting reality in Australia: in 2004 a man named Steven Fielding from the Family First party (think American tea party, you know conservative, homophobic, sexist "family value" type agendas) was elected into the Senate (where all laws have to pass through) on 1.88% (yes that's right just under two per cent) of the vote in Victoria! This was possible because no one got over 50% of primary votes and with the system of votes then flowing to preferences he eventually was the "winner" of the seat! Because he wasn't one of the 2 major parties he then held enormous power in the Senate. Every time a law was being proposed everyone had to lobby and beg him to take their side (or not). And he only got there on the basis of a skewed voting system that allowed him to hold this power on the strength of 210,000 votes out of 12 million votes! But that was not a blip - in last year's election he nearly got re-elected but was "overtaken" by someone else from an obscure little party who got 2.2% of the primary vote - who now sits in the senate and gets to decide on Australian laws! It'd be funny if it wasn't so scary! But that's how the AV system works - it can take unexpected and unintended turns and put people in hugely powerful positions who really shouldn't be there.
 
People who argue pro AV say that with the first past the post system a lot of votes never go into the count. But surely electing someone on the strength of a minute percentage - as can happen in the AV system - wastes 90 odd per cent of the vote.
The preferential (AV) voting system is seriously flawed and certainly, DEMOCRACY IT IS NOT! THe AV system also encourages a lot of  dealings among parties over who to give their preferences to, except once the party is in power no one can hold them to those 'deals'. For example in 2007 in Australia the Greens got a significant number of votes based on environmental concerns such as logging of ancient forrests. Those votes pretty much flowed to Labour so Labour got into power and - guess what - just did what they wanted with no concern of the Greens stance even though they got a large number of votes from them.
 
The AV system will not get rid of a 2 party system, nor will it be a more accurate representation of people's votes.
Anyway, I'll stop blabbing on, I just thought I might give you the story of a country where the AV system is being used. 
 
If you really want to have greater democracy and end the 2 party dominance then the way forward is the proportional representation, but AV is almost the opposite of that. "
     
 And as for me I have decided to vote No. I'm rather traditional when it comes to such things. I liked the Allison Blog on this.

But you will make up your own mind I'm sure! don't let me influence you!