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Author Archives: Richard Bourne

The 5 Year Forward View (5YFV) from 2014 set out the policy for the NHS within a context of the wider care system. It argued that by 2020 the NHS required additional funding of £30bn pa; which was to be met by £22bn of efficiency savings leaving £8bn for additional government funding. Key assumptions were that demand will grow at 3%pa (half through demography and half as quality improvement); provider efficiency will be at 2%pa rising to 3%pa in last 2 years; provider cost inflation at 3%pa. A key feature was “Transformation” with big changes to introduce a range of […]
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I would like to see a Leader of the Labour Party who can deliver the vision for a fairer more just society articulated by Jeremy Corbyn – achieved through a kinder more honest form of politics. The aims and values of the Party are clear in the rules1. The party is a democratic socialist party, committed to change through democratic means not through revolution or mass action2. All members should support the aims of the party and obey the rules including to accept and conform to the constitution, programme, principles and policy of the Party. The role of Party Leader […]
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It is encouraging in many ways to see that there are so many organisations that have been set up to defend the NHS locally and nationally, support the NHS, save the NHS, reinstate the NHS and to keep the NHS public. Many have done great campaigning work and kept at the forefront the guiding principles and values that we all support. Support for the NHS comes from trade unions, and political parties. It is essential that we continue to campaign for the NHS. But what of social care? The NHS has been through a difficult period coping with funding at […]
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With widespread opposition (plus some common sense) the attempt to drive the privatisation of NHS clinical services appears to be stalling. But as one threat diminishes, at least for now, a new one arises: there are increasing attempts to privatise non-clinical services. Outsourcing is now the big threat. Think back to the Thatcher years and the wholesale destabilisation of our local authority services through compulsory competitive tendering. The council’s lost their direct labour teams and private companies got rich pickings from taking contracts.  For local government there is at least an organisation, the Association for Public Service Excellence, which is […]
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The key challenges for care are:- the level of funding is inadequate not enough is done on primary prevention, social determinants of health and inequalities compared to remedial care waits are too long especially for diagnostics the outcomes from the system are not good enough the variation in outcomes is unacceptably large our experience of care is often poor in both health and social care  provision of care is not joined up around the needs of individuals not enough is achieved in terms of reducing inequalities care is still in silos (acute, primary, social, mental health etc) focus on the […]
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Public funds and commissioning need to be in the hands of those who are elected, accountable and representative This article first appeared in the Health Service Journal. There are three main reasons why local authorities ought to also have the strategic responsibility for the planning and commissioning of health services: it brings the democratic accountability we rely on for (almost all) other public services; it allows total public funds for an area to be allocated to best overall advantage and for strategic investment decisions − population based decisions; and it allows for economies of scale − especially in management, administration […]
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The latest in the depressingly long line of attempts to “regulate” healthcare appear to be an Ofsted for Hospitals.  Is this the magic bullet to solve quality issues? It is well established that given any framework of outcomes, objectives or targets there will be a tendency amongst some to game the system – but the latest Ofsted makes that very hard as most of it is based on direct observation of actual teaching.  In schools Ofsted has been evolving for many years and the latest incarnation is probably the least bad. It has a number of key features:- The framework […]
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Most of us would accept that at least in some parts of England the urgent/emergency care system is under considerable stress.  The news is full of it. Most of the sensible and responsible people who understand these things say there is no single simple cause; it is a problem with the whole system.  Our NHS is actually (believe it or not) very efficient but some of that has been gained at the expense of resilience and sustainability – the system works well but at such high capacity that it does not take much for it to become unstable. So we […]
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In the context of whole person we need health services to be aligned with all the other public services. We need to focus on tackling the social determinants of poor health, investing in better health, and only the public service approach can do that.  Only local authorities can be the focal point for bringing public services together.  Only those who are accountable to us through a democratic process should be allowed to make decisions about how public funds are allocated and priorities set. But, the antipathy that exists within the health service to local government is matched only by the […]
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I am often told I need to get out more so I went along to see how my local Clinical Commissioning Group was getting on – in fact to its first proper post authorisation meeting.  I tried to be objective and to listen properly. There were many positives.  The meeting was well run, the papers were available (though not apparently on line in advance) and the CCG itself was able to report it had been authorised without conditions.  It appeared clear that the CCG was clinically led with good GP participation and had a real commitment to patient and public […]
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In October 2012, Monitor appointed a Contingency Planning Team (CPT) to assess the sustainability of Mid Staffordshire FT (MSFT) and develop a long-term plan. The CPT’s interim report concluded that, despite improving clinical performance, its small scale means it is both clinically and financially unsustainable in its current form. The CPT then went on to propose that Stafford Hospital should be downgraded, its services halved and without a 24/7 A&E.  With some minor changes to Cannock Chase Hospital this made a “two local hospitals” solution.  The hospitals will be transferred to other providers and an exercise has begun to invite […]
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Richard Bourne’s acceptance speech: Brain Fisher was warmly thanked for all he has done for the SHA and we are delighted that he intends to keep active and support the officers. Over the next year we will continue to encourage debate and discussion and refine the policies we have established.  We will try to move beyond structures and the NHS and look far more widely; perhaps going back to the basics around the social determinants of health.