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Author Archives: Bob Hudson

The outsourcing of public services to private companies is a model in disarray. The impetus for challenge has been the collapse of the outsourcing giant Carillion but concerns have also been raised across a number of other public services including probation, the prison service, forensic science service, and the NHS. Much less interest has been paid to the longer-standing privatisation of adult social care, where the debate tends to be focused on levels of funding and the respective obligations of the state and citizen to contribute to individual care costs. This relative absence of policy interest in examining the ownership […]
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The issue of citizen accountability in the NHS has been troublesome from the outset. Aneurin Bevan’s preference for centralised control ushered in fifty years of citizen accountability channelled through Parliament and successive health ministers and secretaries of state. As long as patients and the public were satisfied with the way their health services were functioning, there may have been little interest in greater citizen involvement. But the combination of the global recession and the austerity programmes pursued by UK governments since 2010 has changed the situation. Under intense financial pressure, the agency responsible for the day-to-day functioning of the NHS […]
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The NHS is buckling: the scale of the funding challenge is colossal, the service is under unprecedented strain and it is struggling to keep pace with relentlessly rising demand. So says the Commons Health Committee in its recent report into the impact of the 2016 Spending Review on health and social care. Things will only get worse post-Brexit – indeed there is already a ‘financial reset’ in place requiring the NHS to live within its means, including cutting the clinical pay bill. Can technology be a big part of the solution to this situation? It might seem unlikely given the […]
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The shift in the sectoral provision of social care over the last thirty years or so is remarkable, and with funding in excess of £22 billion, this is a large and attractive market. In 1979, 64 per cent of residential and nursing home beds were still provided by local authorities or the NHS; by 2012 it was 6 per cent; in the case of domiciliary care, 95 per cent was directly provided by local authorities as late as 1993; by 2012 it was just 11 per cent. This shift to the private sector has also been accompanied by a growing […]
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Complexity theorists point to the importance of system environment on organisational performance – at one end of the spectrum there is a stable and low change setting, at the other an unstable and high change setting. Since 2010 the NHS has been anything but stable, and the NHS community must be desperate for a spell of stability in 2016. Unfortunately, it is likely to get the opposite – turbulence bordering on chaos. First, there is the ongoing financial turbulence. The pledges of protection for the NHS budget during the 2015 general election have swiftly unravelled. The widely promised extra £8bn […]
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The penny is beginning to drop within the NHS world at last. The seemingly marginal cities and local government devolution bill, now in its Commons committee stage, has major implications for the NHS that have been little discussed and barely comprehended. It all began with Greater Manchester combined authority securing control of its £6bn NHS budget earlier this year, and now several other devolution bids to the Treasury are seeking some NHS remit. The problem here is not so much that the idea is necessarily wrong in principle, but rather that it hasn’t been thought through. Regions seeking such powers […]
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We thought we had a political narrative on the shape of the NHS. David Cameron famously slams “pointless reorganisations” in 2011 but foolishly allows Andrew Lansley to run amok with his Health and Social Care Act in 2012. Jeremy Hunt is then brought in to steady the ship – Lansley having been deemed politically toxic – and we all settle down to making the 2012 structures work as best we can. Yet now we have a new kid on the block – George Osborne, chancellor of the exchequer – shaking up the NHS in revolutionary ways and with no scrutiny […]
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The £6 billion NHS DevoManc deal has been hailed by NHS England CEO, Simon Stevens, as having ‘the potential to be the greatest act of devolution there has ever been in the history of the NHS’. The proposal builds on the 2014 devolution concordat between the Chancellor and the Greater Manchester (GM) councils to devolve the following powers on the understanding these would be exercised by a directly elected mayor: responsibility for a devolved transport budget responsibility for a franchised bus service powers over strategic planning control of a new £300 million housing investment fund assuming the role currently covered by the […]
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A new dilemma in UK health and social care policy? Public services are being outsourced across the world. Over the last year alone the annual contract value for outsourcing across Europe, the Middle East and Africa has increased by 29%, with the United Kingdom showing the highest increase (Information Services Group, 2014). Shortly after the formation of his coalition government in 2010, the UK Prime Minister, David Cameron, declared that he wanted to ‘release the grip of state control’ on public services, and open them up to the private and voluntary sectors (Cameron, 2011). He has delivered on this ambition – the amount spent on outsourcing public services in […]
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For all of its many strengths the NHS has one enduring weakness – it lacks robust local public and patient engagement (PPE). In better times, when people felt the nationally run service was adequately meeting needs, this may not seem to have mattered that much. However now that the NHS and Social Care Act is attempting to palm responsibility for tough decision-making onto local Clinical Commissioning Groups (CCGs) the democratic fault lines are being exposed. It is the right time to ask – can we democratise the NHS? Public and patient engagement (PPE) in the NHS has been weak ever […]
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What do we do when the public services market fails? What happens when outsourced contractors are no longer able or willing to continue with the provision of public services? Bob Hudson explores the downsides of outsourcing public services and finds the proposals currently in train to address ‘market failure’ in both health and social care to be lacking. He goes on to explore alternative approaches and writes that public services should be seen as something more than a contract put out to the market to secure ‘value for money’. Public services are being outsourced across the world. Over the last year alone the annual contract value for outsourcing across Europe, […]
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TEN MESSAGES on PUBLIC and PATIENT ENGAGEMENT ‘Power to the people!’ The Citizen Smith slogan seems to be all the rage in the Labour Party right now as it crafts a distinctive election strategy for the NHS. Pulling away from the role of markets and bringing local accountability into the NHS looks like a good policy double whammy, and the commitment seems genuine. In recent weeks: Ed Miliband, in his Hugo Young lecture committed the next Labour government to ‘people-powered public services’, devolving power not just to users but also to ‘the local level’. Labour’s draft consultation paper on health  […]
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