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Author Archives: Richard Bourne

NHS Providers has accused critics of trusts creating wholly owned subsidiary companies as being “inaccurate and misleading” in their arguments. The body, which represents NHS trusts, believes these companies help attract key staff, deliver VAT savings and increase oversight of previously low priority back office services. It has published a briefing note today saying trust leaders “are clear that wholly owned subsidiaries are a key tool” to deliver current strategic requirements. Nonsense.  The reasons why dozens of Trusts moved to set up wholly owned subsidiary companies over the last 18 months is clear enough.  The change brings the immediate cash […]
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We like to think that we own our NHS.  It’s a public service.  If we do own it, then the joke is on us.  The NHS is now an unaccountable secretive mess and our interests are not being protected.  The people tasked with looking after our interests are bullied or manipulated into amnesia. We are supposed to have the most open and transparent health service in the world, pause here for prolonged laughter.  What we have is a howling mess with providers behaving like autonomous private companies and claiming commercial confidentiality over everything; meeting in private to keep things secret. […]
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Trusts around the country are setting up wholly owned companies to deliver services so they can take advantage of taxation changes this allows. This great VAT saga shows the NHS at its very worst.    Bullied from above, local managers believe the hype from consultants.  They can’t write a proper business case but still launch a project in secret, refuse to consult with staff, totally mislead the staff and public about the real intentions, refuse to give information claiming everything is commercially confidential and plough on regardless – all with the active collusion of a Regulator that is supposed to stop […]
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Some of us that have worked in and around the NHS for years are getting very worried. Not just about the mismatch between aspirations and funding but because of a malaise deep within the NHS itself – the culture might be one word for it. Particular concerns come from those of us who examined the STPs and are now looking at plans for ACS/ACOs; and separately but connected – the sudden outburst of plans to outsource NHS services to wholly owned companies. Parking for now the wisdom of these moves what raises concern is the appalling way the NHS is […]
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The decision to accelerate the development of Accountable Care Organisations (ACOs) in England is unwise, unnecessary and should be challenged.  It is hoped the SHA will support the Judicial Review and the Early Day Motion from Labour. Sadly ploughing ahead with the contracting model for ACOs without any proper explanation, consultation or engagement is typical of what the NHS has been doing, with the secrecy around Sustainability and Transformation Plans as a textbook example of how not to do things.  You cannot make changes on this scale without taking staff patients and public with you – and you should not […]
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Over many years we have seen the NHS develop some really stupid ideas. To be fair realising that they were stupid may only have become obvious with hindsight – but not always. Key characteristics of stupid ideas are that they rest of dubious assertions not solid evidence; they make wildly optimistic assumptions; they lack (or refuse to publish) the details of the case; they are not independently assured; they are driven by outsiders (usually management consultancy firms); and those who decide to go ahead are never there to be accountable when everything goes wrong. Many PFIs, a lot of the […]
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Much of the reporting about the NHS is dubious to say the least. Both the government and those that oppose it are prone to making false claims and also whipping an anecdote into a major issue. Experts are no longer regarded as necessary or valuable. As we move out of the era of markets and competition into what should be a better future we have to find better ways to communicate, to make more effective use of a wealth of actual evidence and also to challenge those peddling false news on social media – even if it means hate mail […]
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The NHS (Private Members) Bill, which once again is looking for a sponsor in Parliament, sets out proposed legislation to return the NHS to the organisational structures that were in place in the 1980s. That was before the purchaser/commission/provider split, before the increase in NHS clinical services being provided by private sector, before the quasi internal external market and before external governance and regulation It is difficult to debate the value of the NHS Bill. It anticipates the closure of hundreds of existing organisations and the creation of hundreds of new ones, across the NHS and local authorities – with […]
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The rationale of the now discredited Health and Social Care Act embedded the idea that the NHS should be regarded as just a collection of services. Regulations required that (with some few exceptions) these services should be tendered out with independent autonomous providers, public and private, competing for the business on a level playing field. The process was overseen by the 200+ Clinical Commissioning Groups who were assumed to have the expertise to understand service requirements, run competitive tendering processes, design appropriate contracts and manage them. This “market” method meant that commissioners could not talk to providers about what might […]
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The NHS 5 Year Forward View was based on an assumption that the NHS would need an additional £30 billion of funding by 20/21 and that £22 billion of that would come through efficiency savings. In its spending review the government “promised” the £8 billion. It is timely to revisit the figures and to look again at what the gap might be in 20/21. (Some informed guesses are all that is provided.) What is attempted here is to cost what restoring the NHS and social care to a decent standard might involve. Since the initial Five Year Forward View we have more […]
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It is always assumed that Labour has a poll lead on the NHS whatever policies it actually has. Going into the 2015 election Labour’s policies around health and care had general approval (in terms of polling evidence). The policies had been through the party policy development process and had a high level of agreement, also passing unscathed through party conference. Whilst the public sort of liked the policies there was a lack of confidence in Labour to deliver anything, however desirable, as well as issues with Labour’s leadership. In terms of health there was a sceptical reaction from anyone within […]
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In 2015 we had the NHS 5 Year Forward View which set out some kind of strategy and was deployed quite well to try for extra funding.  Most of the aspirations in the 5 Year Forward View were noble enough and the suggested approach such as it was made some sense. Of course the 5 Year Forward View was denounced as privatisation but the reality was that words like choice, competition and private were not prominent.  The era of St. Simon largely erased the legacy of LaLa Lansley. We now have a 3½ Year Forward View as not much has […]
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