Monday 29 April 2013

No Iain

An interesting suggestion from Iain Duncan Smith for rich oldies to hand their bus passes and fuel benefits back. I shall not be taking advantage of this suggestion. In fact it will be entirely ineffective. I take full advantage of Boris's freedom pass and have no intention of giving that up, especially when the Government are implementing appalling changes to the welfare system. If I thought my small contribution might alleviate the pain being inflicted on the disabled by his changes in the current system that might be a different matter. It won't.

His call would have had more effect if he had urged those oldies who can afford it, to give the benefits to charity. I absolutely agree those who reach older age and can afford it should give generously to charity.

In the longer term it does seem increasingly likely that Governments will need to look at the costs of the current universal benefits. Given the rate of demographic change it is simply not tenable to continue paying these benefits to those who do not need them and when the financial burden of continuing universal benefits will come at the expense of other parts of the welfare system.

Thursday 25 April 2013

Sitting with Churchill...

So to speak; although what I mean is that I'm blogging from the Churchill Room in HMT. It’s the room where Churchill stood on the balcony to address the crowds at the end of the War. 

It’s a “Working Chance" breakfast. A brilliant charity that is dedicated to finding jobs for women ex-prisoners. Led dynamically by ACEVO member, Jocelyn Hillman, it has a daunting track record of getting ex offenders into jobs and into a new life, when the national record for reoffending is so crap. 

If you are a charity CEO why not think about whether you might be able to find a work placement or job for a woman ex offender then contact them -

Richard Branson said of them, “I use working chance because its a great recruitment agency and they give me what I need”! Not a bad recommendation I guess. 

Last night was fun! I was speaking at the farewell party in the RSA for Derek Twine. He has been the superb CEO of the Scouts since 1996. So I have known Derek as a friend and colleague ever since I took over at ACEVO. It was a great gathering of sector folk and hangers on. Doing my research for my speech I discovered it’s Derek Milton Twine. So good old Google gave me some great quotes, though regrettably John Milton is not really into humour or quips!

It was a great end of a day which had started with me giving a keynote speech at a Westminster Health Forum on the role of Health Watch - the new NHS body that will represent “patients". I was fairly forthright on what I saw as their challenges and the huge potential they have. They could spend a lot of time nagging away at councils or worrying about who sits on their committees or whether they should be elected. Tesco is deeply interested in their customers. They spend massive time and energy on surveying and asking consumers what they want. They don't set up a committee to do this! I also suggested we need to concentrate on what the public want. What citizens want from a health and social care system. Most of us are not “patients". We don’t want to be either. But we use the NHS. We need care services for us or friends and relatives. And health watch needs to champion choice, not the public sector providers. This is an area that has been bedeviled by self appointed patient spokespersons and failed or aspirant politicians and people who think it’s an opportunity to start the revolution. There are also some great people and professional staff who can make a difference. Health Watch England have a great CEO and Chair. It’s a new body and I wish them well.

Wednesday 24 April 2013

State sponsored lunacy

Many years back a certain Michael Lyons produced a block buster report on Local Government. I was at the launch and spotted , buried in the middle an absurd proposal to remove the business rates exemption from charity shops. I sprang into action. Within hours I had managed to get the Labour Government to say they would not implement a self evidently stupid proposal.

Now years on we must have that battle again , but in Wales where this idea has resurfaced from the Welsh Government.

The Welsh Government’s proposals for a tax hike on high street charities are state-sponsored lunacy. Charity shops in Wales do not just provide much needed funding for good causes, they also provide hundreds of jobs and thousands of volunteering opportunities, providing employment and skills to communities across Wales. The proposal to hit those charity shops with more tax will mean less money for good causes, and fewer employment opportunities for people in Wales. The Welsh Government must see sense and drop this proposal.

And just what do they think will happen if charity shops close down!  Will they be replaced by lovely craft emporia.. Splendid cafes. Or will they be replaced by empty boarded up spaces or loan shark offices?  Lets hear it for charity shops. They are keeping our high streets alive. Some are truly lovely places to shop. My curtains in Charlbury are courtesy of the Helen Douglas hospice shop in Chipping Norton. I love shopping in them. So do many people. And the fact we know that supports the great work of charities is such a brilliant idea.

So get a grip Welsh Government. Drop this now. Or face the wrath of the united powers of the Welsh charity and voluntary sector. I'm booking my train tickets.......

Friday 19 April 2013

Winds of change? Radical reform for health needed

In retrospect, Danny Boyle may not have done us a favour? Do politicians need to stop the rhetoric about how the NHS is a national treasure (which it is)and get to grips with the crying need for radical reform? Yes- in many ways it is a national treasure but that may sometimes justify a woolly approach to a growing crisis in our health service. As Norman Lamb, the Health Minister said at a recent ACEVO health conference the NHS is often described as a national religion so any proposal for change can be seen as heresy. We must not avoid a sensible debate on radical options for change. Many of us would argue that the resource problems are no so great that without reform the treasure of a free universal service will come under threat.

This is the message of ACEVO's Taskforce on Prevention in Health, chaired by Sir Hugh Taylor, which launched its report on Wednesday at our Health and Social Care Conference. The Prevention Revolution: Transforming Health and Social Care sets out some key recommendations aimed at shifting resources from reactive, clinical services to integrated, preventative services, which support better self-management of conditions, more home and community-based care, and better support to address the social determinants of health. It emphasis's the need for new, innovative providers from the voluntary sector to pioneer new ways of working and achieve real cultural change.

I would argue for a radical look at our 1948 health model, which builds on the advances in medical care and great hospitals but now starts the shift of resources to community care and prevention.  Health and wellbeing has changed dramatically over the last 65 years. Now even cancer is increasingly a long-term condition. But our resources continue to be dominated by acute care, not prevention or community care.

I've watched the debate on health develop since that big listening exercise in 2011 where I played a somewhat controversial role in arguing for more choice for patients. I remember people telling me patients don't want choice. Well, since then that patronising and damaging claim has been shot away. With the continuing exposure of poor to sometimes criminal neglect in some hospitals, who can now doubt that choice is important. I doubt the relatives of those who died at Mid Staffs were worried about the colour of the uniform of the staff - whether that was an NHS, private or charity uniform.

It's not just Francis. The recent report from the CQC, which states that older people in nearly a fifth of hospitals are not being treated with dignity or afforded the respect they need, is damning. Then there is the independent report by Bristol University on a 3 year study about the handling of the care of those most vulnerable; people with learning disabilities. Such patients are dying on average more than 16 years sooner than anyone else and it shows catastrophic failings in care contributed to this.

We know there is also huge professionalism and dedication in our health service at all levels; innovation and medical advances that benefit us all. We know of dedicated doctors and nurses who go the extra mile. We should avoid the trap that assumes, post Francis, all NHS hospitals neglect patients. But the reality is that the case for radical change is strong and getting stronger.

The financial problems of the service are masked by the supposed Treasury decision to protect spending. In fact, as health inflation rises more than general inflation each year resources for health (and of course council resources for care) decline. And medical advances and an ageing population with growing chronic illness add further pressure.

The Nuffield Trust predicts that an ageing population in an unchanged NHS will cost an extra £54bn from 2011 to 2022. And that ageing population will be living with a range of long term conditions that will sometimes require medical intervention but more often will need care and support in the community.

Increasingly citizens are getting ahead of the politicians in understanding there are good hospitals, excellent hospitals and bad ones. Good doctors and surgeons and bad ones. And they want to choose the good ones, but our producer-dominated system often either denies them that choice or does not provide the information needed to enable it .

A recent poll by ICM asked people what they thought of this statement:

“It shouldn’t matter whether hospitals or surgeries are run by the government, not-for-profit organisations or the private sector, provided that everyone including the least well-off has access to care”.

83% agreed with this – 56% strongly, while only 14% disagreed, 10% strongly.

Yet the political parties are frightened to embrace the obvious: that what matters is what works, not who provides the service. If a private hospital cares for its patients better, then people should be able to choose it. If one NHS hospital is better than another then let people choose it. If people at the end of life want to be supported at home or in a hospice why do we deny then that choice. And at the beginning of life why do we so often deny mothers the right to a home birth?

To give you a very practical problem, some 7,000 people a year have their foot or toe amputated as a result of their diabetes, but we know proper advice and support and practical assistance for people with diabetes could dramatically reduce that figure.

So we need to move resources from hospitals to community. Just as in the 80s, we started the revolution in the care of mental health by closing asylums and developing care in the community, we now need to close and reorganise hospitals, reshape their services and move resources to prevention, to integrated care usually provided in communities and where charities are in the lead. This does not necessarily mean we should close a hospital. We should equally be considering how we change and adapt these assets in a different way. Reshaping the services they provide to acknowledge the changes brought about by a growing elderly population and chronic illness. Developing Community or cottage hospitals. Centres for integrated care.  Contracting for partnerships to run such hospitals between the private, third and public sectors.

Indeed by ensuring more frail elderly people receive proper care and appropriate medical support in the community will enable hospitals to concentrate their skill in tackling the more difficult and problematic diseases and advancing the boundaries of medical science.

So who needs to do what?

There are hundreds of well resourced, professional charities. World leaders. Masters of innovation. Close to their members and communities. Advocates and champions of patients. Experts and repositories of knowledge. We need to commission them more.  It is by growing the charity and social enterprise sector that we can help to start that shift in resources to prevention and community support.

It will require the new CCGs to actively revise their commissioning policies and strategy. To contract differently.  To look at what is being spent on the frail elderly and on dementia, and demand that it is done better. To review spend on long-term conditions and to seek alternative approaches. To work with local councils to develop public health strategies that promote wellbeing.

We need the 19 commissioning support units to actively promote the third sector and to provide practical support to CCGs who want to engage with that sector.

And the new National Commissioning Board could be key to encouraging a culture of change and innovation, rather than rules adherence and risk avoidance. Will it?

I think that local councils could play a significant role in demanding change. We need the new Health and Well Being boards to flex their muscles. Few in the health system have understood that a determined HWB could be an engine for change and a powerful push to challenge complacency. They need to challenge and take on the power of vested interests in favour of their communities.

And what of the politicians? Both parties are showing a timidity of approach and a lack of courage in confronting challenges. Competition is not a disease. Well managed and regulated competition opens up choices. It delivers better for citizens and taxpayers. So let's encourage people to exercise choice and encourage challenge from patients and citizens. That means being open to different sectors and using competition as a force to promote choice. I don't believe in competition being forced on the health service but I do believe in citizens demanding that when they see bad provision they secure change. If that means charities or the independent sector provide more, then so be it. It's bottom-up reform. It's the power of challenge to entrenched interests that could see reform and the Parties need to promote and encourage that. We cannot support notions of the NHS as a "preferred provider" in the wake of Francis. That would be to assume  the interest of the provider is more important than that of the citizen and patient. It is that culture we must change.

In the choice and competition report of the listening exercise we recommended a statutory right to challenge (as enshrined in local government law). We need that done now.
  But this also means the third sector needs to reflect on whether its own organisation and structures meet the new commissioning world. We need to do more to promote consortia working and alliances amongst charities and social enterprises. That might be amongst like charities at national and at local level. Or with private and public sector providers, including direct work with hospitals.

That is the work ACEVO will be doing; with our members and with partners like the NHS Alliance, NAPC, the Foundation Trust Network and colleagues in our sector.

Is there a “wind of change" in the NHS? We can see the signs. But now we need Government and Opposition to wake up to their leadership role in being radical for reform.

Thursday 18 April 2013

Postcard from Zimbabwe.

There are occasions in life when one deserves treats; and getting to 60 must be one of them? I love train travel and one of the world's great journeys is the South African Blue Train. As you can see I rather enjoyed it.

We were heading for the Victoria Falls; once you could take the train all the way there but alas Mugabe has put a stop to that, so we flew the last part from Pretoria. It was a marvel. 

"Scenes so lovely must have been gazed upon by angels in their flight"

David Livingstone.
16 November 1855

Walking round the Falls is a wet experience. The spray from the thundering waters reaches high and far. You need a raincoat but I still got drenched. So the helicopter flight across the Falls was a must. Cecil Rhodes great dream was a rail line from Cape Town to Cairo. It never happened but part of the line was to cross the Falls and in 1905 an English construction company built the magnificent rail bridge across the Gorge. As it was a NE company it rather resembles the bridge on the Tyne, which is not mine as the song goes! They also built the Victoria Falls Hotel at the same time. Opening in 1904 this hotel will forever be Southern Rhodesia. A great colonial edifice where the sun never sets on the somewhat faded Imperial glories. Queen Mary and King George loom over the drawing room and the lavatories are a marvelous period piece such as one now rarely sees in the UK. We were hoping to stay but it was full. I did however do lunch; fish and chips and mushy peas (though the fish was a tasty Zambezi river bream) and then High Tea (the full works: scones, perfectly cut sarnis and cakes). Sitting on the veranda you get a marvelous view over to the Gorge Bridge and the spray from the Falls. The clue to the fact that it is not England was the appearance of a group of wart hogs and Guinea fowl on the perfectly manicured lawns!

We also took a stroll over the bridge into Zambia. It’s the best spot for a view of the feckless young people who throw themselves off the Bridge. Bungee jumping its called. Madness I say. The stroll did however entail a return trip through Zim immigration and customs. 

As it turned out we were lucky not to get a room at the hotel as we ended up in the Gorges Lodge. It turned out to be one of the best places I've stayed in. Just 10 thatched lodges set along the top of the Gorge, carved out by the force of the flow from the Falls over the millennia. Far below runs the mighty lower Zambezi. And on the opposite side is Zambia. Sitting outside our Lodge we are 3 feet from the edge. No 'ealth and safety officers have been here to erect safety barriers so too much drinking is not recommended. And I have sat here listening to the sounds of the Bush and watching the sunrise and the sunset. 

The photos from here give you an idea of the beauty and the quiet.

We are some 23km from the noise and bustle of the town of Victoria Falls. A typical African town but the only difference is that you can't actually use the local currency. Everything is sold in dollars or rand. So a strange experience popping into the local supermarket to get a bag of loose leaf Zim tea to pay in dollars and get change in rand. A commentary on the deprivations of the Mugabe regime that he has so far devalued his national currency that people now don't use it. Lads on the street were keen to sell me the trillion dollar Zim bank notes that now have only amusement value. But it's a happy go lucky spot with few signs of political turmoil, though one hopes for change as this is a country rich in natural resources and great beauty. They deserve better governance.