quity and excellence'

[Guest guest]

The new White Paper is called 'Equity and excellence: liberating the NHS'. Attached, or it can be downloaded from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353There is talk of ring fencing budgets fro public health and a public health white paper in the autumn, but it is not at all clear to me (perhaps I haven't reached that bit yet) what will and what will not be regarded as public health. Will school nursing and health visiting services come under that budget, or expect to fight for survival alongside the new 'liberated hospitals' ? There are to be 'empowered professionals,' which sounds good, but exactly how that is to happen when it is only GPs who will have spending power is not clear, either.best wishes Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

1 of 1 File(s)

dh_117352.pdf

[Guest guest]

Can it get much worse from how the PCTs manage us, which is appalling?Sent from my BlackBerry smartphone from Virgin MediaFrom: "Ann Girling" <ann@...>Sender: Date: Tue, 13 Jul 2010 09:00:59 +0100< >Reply Subject: RE: quity and excellence' Hear, hear . It worries me to bits with GP’s having allthis power. We will be increasingly a national sickness service, Ann Ann GirlingPersonal Development & Wellbeing Coach Tel: 01244 300391 Mobile: 07787 568699www.onthethreshold.co.uk From: [mailto: ] On Behalf Of CowleySent: 12 July 2010 17:06 Subject: quity and excellence' [1 Attachment] The new White Paper is called 'Equity and excellence: liberating the NHS'. Attached, or it can be downloaded from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_117353 There is talk of ring fencing budgets fro public health anda public health white paper in the autumn, but it is not at all clear to me(perhaps I haven't reached that bit yet) what will and what will not beregarded as public health. Will school nursing and health visitingservices come under that budget, or expect to fight for survival alongside thenew 'liberated hospitals' ? There are to be 'empowered professionals,' whichsounds good, but exactly how that is to happen when it is only GPs who willhave spending power is not clear, either. best wishes Cowleysarahcowley183btinternethttp://myprofile.cos.com/S124021COn No virusfound in this incoming message.Checked by AVG - www.avg.comVersion: 9.0.830 / Virus Database: 271.1.1/3001 - Release Date: 07/12/1017:49:00

[Guest guest]

Hi I don't work for a PCT but I listen to lots of staff who do and most of them seem to be getting a pretty bad experience so I tend to agree with you. Can the GPs do any worse?It sounds like we may may have an increase in social enterprise organisations too. What a melting pot! HornerLecturerFrom: "sarahforsyth7ry@..." <sarahforsyth7ry@...> Sent: Tue, 13 July, 2010 9:26:24Subject: Re: quity and excellence'

Can it get much worse from how the PCTs manage us, which is appalling?Sent from my BlackBerry smartphone from Virgin MediaFrom: "Ann Girling" <annagenesis (DOT) co.uk>

Sender:

Date: Tue, 13 Jul 2010 09:00:59 +0100<>Reply

Subject: RE: quity and excellence'

Hear, hear . It worries me to bits with GP’s having all

this power. We will be increasingly a national sickness service, Ann

Ann Girling Personal Development & Wellbeing Coach Tel: 01244 300391 Mobile: 07787 568699 www.onthethreshold. co.uk

From:

[mailto:SENATE- HVSN@groups .com] On Behalf Of Cowley

Sent: 12 July 2010 17:06

Subject: quity and excellence' [1 Attachment]

The new White Paper is called 'Equity and excellence:

liberating the NHS'. Attached, or it can be downloaded from

http://www.dh. gov.uk/en/ Publicationsands tatistics/ Publications/ PublicationsPoli cyAndGuidance/ DH_117353

There is talk of ring fencing budgets fro public health and

a public health white paper in the autumn, but it is not at all clear to me

(perhaps I haven't reached that bit yet) what will and what will not be

regarded as public health. Will school nursing and health visiting

services come under that budget, or expect to fight for survival alongside the

new 'liberated hospitals' ? There are to be 'empowered professionals, ' which

sounds good, but exactly how that is to happen when it is only GPs who will

have spending power is not clear, either.

best wishes

Cowley

sarahcowley183@ btinternet. com

http://myprofile. cos.com/S124021C On

No virus

found in this incoming message.

Checked by AVG - www.avg.com

Version: 9.0.830 / Virus Database: 271.1.1/3001 - Release Date: 07/12/10

17:49:00

[Guest guest]

Maybe you’re all right .. but I remain concerned. Is there a

better answer??

Ann Girling

Personal Development & Wellbeing Coach

Tel: 01244 300391    Mobile: 07787 568699

www.onthethreshold.co.uk

      

From:

[mailto: ] On Behalf

Of sandra horner

Sent: 13 July 2010 18:34

Subject: Re: quity and excellence'

Hi

I don't work for a PCT but I listen to lots of staff who do and most of them

seem to be getting a pretty bad experience so I tend to agree with you. Can the

GPs do any worse?

It sounds like we may may have an increase in social enterprise organisations

too. What a melting pot!

Horner

Lecturer

From:

" sarahforsyth7ry@... "

<sarahforsyth7ry@...>

Sent: Tue, 13 July, 2010 9:26:24

Subject: Re: quity and excellence'

Can it get much worse from how the PCTs manage us, which is appalling?

Sent from my BlackBerry smartphone from Virgin Media

From: " Ann Girling " <annagenesis (DOT)

co.uk>

Sender:

Date: Tue, 13 Jul 2010 09:00:59 +0100

<>

Reply

Subject: RE: quity and excellence'

Hear, hear . It worries me to bits

with GP’s having all this power. We will be increasingly a national sickness

service,

Ann

Ann Girling

Personal Development &

Wellbeing Coach

Tel: 01244

300391 Mobile: 07787 568699

www.onthethreshold. co.uk

From:

[mailto:SENATE- HVSN@groups .com] On

Behalf Of Cowley

Sent: 12 July 2010 17:06

Subject: quity and excellence' [1 Attachment]

The

new White Paper is called 'Equity and excellence: liberating the NHS'.

Attached, or it can be downloaded from

http://www.dh. gov.uk/en/ Publicationsands tatistics/

Publications/ PublicationsPoli cyAndGuidance/ DH_117353

There

is talk of ring fencing budgets fro public health and a public health white

paper in the autumn, but it is not at all clear to me (perhaps I haven't

reached that bit yet) what will and what will not be regarded as public health.

Will school nursing and health visiting services come under that budget,

or expect to fight for survival alongside the new 'liberated hospitals' ? There

are to be 'empowered professionals, ' which sounds good, but exactly how that

is to happen when it is only GPs who will have spending power is not clear,

either.

best

wishes

Cowley

sarahcowley183@

btinternet. com

http://myprofile.

cos.com/S124021C On

No virus found in this incoming message.

Checked by AVG - www.avg.com

Version: 9.0.830 / Virus Database: 271.1.1/3001 - Release Date: 07/12/10

17:49:00

No virus

found in this incoming message.

Checked by AVG - www.avg.com

Version: 9.0.830 / Virus Database: 271.1.1/3002 - Release Date: 07/13/10

07:36:00

[Guest guest]



Dear Colleagues,

I have returned from France and would like to add the policy perspectives I had promised a month ago. Apologies to everyone for the breadth of this "offering" and thanks to all for the documents shared on Senate.

The Coalition's White Paper on the NHS is only partly a suprise.

We knew from conversations before the election that this re-structuring was likely to be in the Conservative Party's planning for the NHS. Much of the new structure for the NHS is an extension of the approach implemented by the Conservatives during the 1980s/1990s (from 1984).

The abolition of both SHAs and PCTs was something we anticipated. The plan is to replace them by commissioning bodies that are much larger in number than the current # of PCTs -- individual GPs will not be commissioners. Consortia of (and on behalf of GPs) will take on the role of the previous PCTs. GPs will hand the commissioning role to managers in consortia. We can anticipate that some of these will be contracted from the private sector -- this is infrastructure management. It is a step toward de-centralization of the NHS and it is also a move towards a mixed economy NHS.

The likely scenario will also be a move to focus the NHS budget entirely on clinical needs and services.

Public health is a small and separate focus and could very well move to local authority responsibility and local authority employment packages. The Children's and Young People's Plans are already in statute and their Boards have responsibility for the kinds of health and social care that health visitors and school nurses provide. In addition, many were already moving away from employing Directors of Public Health before the election and have been conducting population health needs assessments in line with the statue required Joint Strategic Needs Assessments. All of this is simply to say that contracting individual services for children (such as HVs and SNs) will move to local decision making and local models led by partnerships of local public sector and voluntary bodies with some involvement of the private sector.

The point I am making first is that all guidance documents (e.g., the HCP [0-19]) are technically redundant. Only statute must be respected by a new government. All else can be ignored or changed by fiat.

Those of you who know my work will know that I have argued for many years that we need outcome measures rather than caseload measures in order to convince commissioners of the value of School Nursing and of Health Visiting. That is still true, indeed more so than ever. And with the new White Paper, the NHS is entirelly driven by outcomes. This is something that school nursing and health visiting have found it difficult to articulate with sound evidence.

There is not a response in the NHS to the "moral" arguments about providing good services for children and young people. Instead, the arguments that matter are political pressure and fiduciary. It is unlikely that "good work" cuts much ice nationally.

In addition, we are still in the position of trying to find ways of publicly describing the work of these staff. It simply isn't possible for the end user or the commissioner to "know" the complexity of school nursing and health visiting services without very sophisticated forms of public communication. We also need to be able to communicate the multi-purpose and multi-partnership work of these workforces. On the whole, most people outside the NHS (and many inside the NHS) simply don't know what HVs and SNs do. They have stereotypical "pictures" and they have "individual experiences" -- not sufficient arguments to persuade investment. This is a task of public communication and SNs and HVs need to be clear about the roles within the combined services for children -- not simply as single acting professionals.

They also need high profile and influential advocates who have power.............

With regard to transfer of employment to local authorities. The White Paper makes that very easy to do, in theory. Sir Nicholson, head of the NHS, commented yesterday that "Staff may also experience change in who they work for and the nature of their work". I do believe that school nursing and health visiting could be likely candidates for this. In fact, that was the case for school nursing from 1948 to 1974. And in some parts of the country, this is already on local authority agendas.

However, there is a complicating factor here. I have looked at a number of Local Authority financial plans (out in the last month). Because the % cut in local authority budgets is so very large, it is the case that many are reducing staff numbers drastically -- first via not replacing vacancies and not replacing retirement posts. This first step will be followed by reductions in services and the Coalition has removed ring fencing from local authority budgets. This means that decisions about what can be cut are locally determined with considerable freedom.

I just want to stop there but point out that the Public Health speech by Lansley does not mention that regulations on food and drinks manufacturers have been removed. Obesity, alcohol abuse, and smoking will not be regulated (e.g., food labelling requirements; increasing the taxes on alcohol and tobacco and such like). Instead the manufacturers will be given the task of discouraging people from buying their products!

In summary, we will see a great diversity of interpretation and planning decisions across the country. Dr Sam Everington's description of a radical new concept of GP practice is a model of what we call "social capital"..................but there will not be incentives to transfer this model elsewhere. Indeed, he is describing a model of "social medicine" that is rare, innovative, and imaginative. But there is nothing I can see in the White Paper to encourage this to happen elsewhere -- apart, that is, from the rare leadership that places community above individuality, etc.

The opportunity, therefore, is in the leadership SNs and HVs can support and provide that will mime this model at very local levels.

I look forward to your responses. My intention is to find a way for us to understand the larger picture and how we can make a difference not only to workforce numbers but to workforce imagination.

V best,

Diane

However, there is a serious problem in local authority

quity and excellence' [1 Attachment]

The new White Paper is called 'Equity and excellence: liberating the NHS'. Attached, or it can be downloaded from

http://www.dh. gov.uk/en/ Publicationsands tatistics/ Publications/ PublicationsPoli cyAndGuidance/ DH_117353

There is talk of ring fencing budgets fro public health and a public health white paper in the autumn, but it is not at all clear to me (perhaps I haven't reached that bit yet) what will and what will not be regarded as public health. Will school nursing and health visiting services come under that budget, or expect to fight for survival alongside the new 'liberated hospitals' ? There are to be 'empowered professionals, ' which sounds good, but exactly how that is to happen when it is only GPs who will have spending power is not clear, either.

best wishes

Cowley

sarahcowley183@ btinternet. com

http://myprofile. cos.com/S124021C On

No virus found in this incoming message.Checked by AVG - www.avg.comVersion: 9.0.830 / Virus Database: 271.1.1/3001 - Release Date: 07/12/10 17:49:00

No virus found in this incoming message.Checked by AVG - www.avg.comVersion: 9.0.830 / Virus Database: 271.1.1/3002 - Release Date: 07/13/10 07:36:00

[Guest guest]

Dear DianeThank you for your thoughtful critique. HSJ are reporting (surprise!) that the White Paper has sent everyone into a spin as they worry about their jobs; well why wouldn't it?I think you are right, that much of this is continuity with what went before (from New Labour as well as old Tory), much is about privatisation and balancing the books (especially all that talk of 'freeing up' foundation trusts so their finances don't appear in public spending totals) and much of the change was predicted. I even think there are some potentially positive elements about the plans but, as they say, the devil is in the detail. I think the big question for health visitors and school nurses is where they will fall in this carve up of responsibilities: 1. Will their services will fall into the large pot that GPs have to commission (potentially not such a bad thing, as GPs generally know more about health visiting than PCT commissioners, but scary for those of us with bad memories of GP fundholding)2. Will they fall under the same umbrella as GPs themselves, and be commissioned directly by the NHS board? Could be something to aim for, as at present the government is saying they want to commission more, but need to think about the long term.3. Will they be seen as part of 'public health,' which I think is to be commissioned by the NHS Board but with far closer links to local government; 4. Or will they be seen as part of local government children's services? As you say, Diane, the problem then is the cost-cutting going on there.I haven't been able to unravel that thinking from the paper yet, but perhaps all will become clear in due course. best wishesOn 14 Jul 2010, at 14:09, Diane DeBell wrote:Dear Colleagues, I have returned from France and would like to add the policy perspectives I had promised a month ago. Apologies to everyone for the breadth of this "offering" and thanks to all for the documents shared on Senate. The Coalition's White Paper on the NHS is only partly a suprise. We knew from conversations before the election that this re-structuring was likely to be in the Conservative Party's planning for the NHS. Much of the new structure for the NHS is an extension of the approach implemented by the Conservatives during the 1980s/1990s (from 1984). The abolition of both SHAs and PCTs was something we anticipated. The plan is to replace them by commissioning bodies that are much larger in number than the current # of PCTs -- individual GPs will not be commissioners. Consortia of (and on behalf of GPs) will take on the role of the previous PCTs. GPs will hand the commissioning role to managers in consortia. We can anticipate that some of these will be contracted from the private sector -- this is infrastructure management. It is a step toward de-centralization of the NHS and it is also a move towards a mixed economy NHS. The likely scenario will also be a move to focus the NHS budget entirely on clinical needs and services. Public health is a small and separate focus and could very well move to local authority responsibility and local authority employment packages. The Children's and Young People's Plans are already in statute and their Boards have responsibility for the kinds of health and social care that health visitors and school nurses provide. In addition, many were already moving away from employing Directors of Public Health before the election and have been conducting population health needs assessments in line with the statue required Joint Strategic Needs Assessments. All of this is simply to say that contracting individual services for children (such as HVs and SNs) will move to local decision making and local models led by partnerships of local public sector and voluntary bodies with some involvement of the private sector. The point I am making first is that all guidance documents (e.g., the HCP [0-19]) are technically redundant. Only statute must be respected by a new government. All else can be ignored or changed by fiat. Those of you who know my work will know that I have argued for many years that we need outcome measures rather than caseload measures in order to convince commissioners of the value of School Nursing and of Health Visiting. That is still true, indeed more so than ever. And with the new White Paper, the NHS is entirelly driven by outcomes. This is something that school nursing and health visiting have found it difficult to articulate with sound evidence. There is not a response in the NHS to the "moral" arguments about providing good services for children and young people. Instead, the arguments that matter are political pressure and fiduciary. It is unlikely that "good work" cuts much ice nationally. In addition, we are still in the position of trying to find ways of publicly describing the work of these staff. It simply isn't possible for the end user or the commissioner to "know" the complexity of school nursing and health visiting services without very sophisticated forms of public communication. We also need to be able to communicate the multi-purpose and multi-partnership work of these workforces. On the whole, most people outside the NHS (and many inside the NHS) simply don't know what HVs and SNs do. They have stereotypical "pictures" and they have "individual experiences" -- not sufficient arguments to persuade investment. This is a task of public communication and SNs and HVs need to be clear about the roles within the combined services for children -- not simply as single acting professionals. They also need high profile and influential advocates who have power............. With regard to transfer of employment to local authorities. The White Paper makes that very easy to do, in theory. Sir Nicholson, head of the NHS, commented yesterday that "Staff may also experience change in who they work for and the nature of their work". I do believe that school nursing and health visiting could be likely candidates for this. In fact, that was the case for school nursing from 1948 to 1974. And in some parts of the country, this is already on local authority agendas. However, there is a complicating factor here. I have looked at a number of Local Authority financial plans (out in the last month). Because the % cut in local authority budgets is so very large, it is the case that many are reducing staff numbers drastically -- first via not replacing vacancies and not replacing retirement posts. This first step will be followed by reductions in services and the Coalition has removed ring fencing from local authority budgets. This means that decisions about what can be cut are locally determined with considerable freedom. I just want to stop there but point out that the Public Health speech by Lansley does not mention that regulations on food and drinks manufacturers have been removed. Obesity, alcohol abuse, and smoking will not be regulated (e.g., food labelling requirements; increasing the taxes on alcohol and tobacco and such like). Instead the manufacturers will be given the task of discouraging people from buying their products! In summary, we will see a great diversity of interpretation and planning decisions across the country. Dr Sam Everington's description of a radical new concept of GP practice is a model of what we call "social capital"..................but there will not be incentives to transfer this model elsewhere. Indeed, he is describing a model of "social medicine" that is rare, innovative, and imaginative. But there is nothing I can see in the White Paper to encourage this to happen elsewhere -- apart, that is, from the rare leadership that places community above individuality, etc. The opportunity, therefore, is in the leadership SNs and HVs can support and provide that will mime this model at very local levels. I look forward to your responses. My intention is to find a way for us to understand the larger picture and how we can make a difference not only to workforce numbers but to workforce imagination. V best, Diane Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]

Dear DianeThank you for your thoughtful critique. HSJ are reporting (surprise!) that the White Paper has sent everyone into a spin as they worry about their jobs; well why wouldn't it?I think you are right, that much of this is continuity with what went before (from New Labour as well as old Tory), much is about privatisation and balancing the books (especially all that talk of 'freeing up' foundation trusts so their finances don't appear in public spending totals) and much of the change was predicted. I even think there are some potentially positive elements about the plans but, as they say, the devil is in the detail. I think the big question for health visitors and school nurses is where they will fall in this carve up of responsibilities: 1. Will their services will fall into the large pot that GPs have to commission (potentially not such a bad thing, as GPs generally know more about health visiting than PCT commissioners, but scary for those of us with bad memories of GP fundholding)2. Will they fall under the same umbrella as GPs themselves, and be commissioned directly by the NHS board? Could be something to aim for, as at present the government is saying they want to commission more, but need to think about the long term.3. Will they be seen as part of 'public health,' which I think is to be commissioned by the NHS Board but with far closer links to local government; 4. Or will they be seen as part of local government children's services? As you say, Diane, the problem then is the cost-cutting going on there.I haven't been able to unravel that thinking from the paper yet, but perhaps all will become clear in due course. best wishesOn 14 Jul 2010, at 14:09, Diane DeBell wrote:Dear Colleagues, I have returned from France and would like to add the policy perspectives I had promised a month ago. Apologies to everyone for the breadth of this "offering" and thanks to all for the documents shared on Senate. The Coalition's White Paper on the NHS is only partly a suprise. We knew from conversations before the election that this re-structuring was likely to be in the Conservative Party's planning for the NHS. Much of the new structure for the NHS is an extension of the approach implemented by the Conservatives during the 1980s/1990s (from 1984). The abolition of both SHAs and PCTs was something we anticipated. The plan is to replace them by commissioning bodies that are much larger in number than the current # of PCTs -- individual GPs will not be commissioners. Consortia of (and on behalf of GPs) will take on the role of the previous PCTs. GPs will hand the commissioning role to managers in consortia. We can anticipate that some of these will be contracted from the private sector -- this is infrastructure management. It is a step toward de-centralization of the NHS and it is also a move towards a mixed economy NHS. The likely scenario will also be a move to focus the NHS budget entirely on clinical needs and services. Public health is a small and separate focus and could very well move to local authority responsibility and local authority employment packages. The Children's and Young People's Plans are already in statute and their Boards have responsibility for the kinds of health and social care that health visitors and school nurses provide. In addition, many were already moving away from employing Directors of Public Health before the election and have been conducting population health needs assessments in line with the statue required Joint Strategic Needs Assessments. All of this is simply to say that contracting individual services for children (such as HVs and SNs) will move to local decision making and local models led by partnerships of local public sector and voluntary bodies with some involvement of the private sector. The point I am making first is that all guidance documents (e.g., the HCP [0-19]) are technically redundant. Only statute must be respected by a new government. All else can be ignored or changed by fiat. Those of you who know my work will know that I have argued for many years that we need outcome measures rather than caseload measures in order to convince commissioners of the value of School Nursing and of Health Visiting. That is still true, indeed more so than ever. And with the new White Paper, the NHS is entirelly driven by outcomes. This is something that school nursing and health visiting have found it difficult to articulate with sound evidence. There is not a response in the NHS to the "moral" arguments about providing good services for children and young people. Instead, the arguments that matter are political pressure and fiduciary. It is unlikely that "good work" cuts much ice nationally. In addition, we are still in the position of trying to find ways of publicly describing the work of these staff. It simply isn't possible for the end user or the commissioner to "know" the complexity of school nursing and health visiting services without very sophisticated forms of public communication. We also need to be able to communicate the multi-purpose and multi-partnership work of these workforces. On the whole, most people outside the NHS (and many inside the NHS) simply don't know what HVs and SNs do. They have stereotypical "pictures" and they have "individual experiences" -- not sufficient arguments to persuade investment. This is a task of public communication and SNs and HVs need to be clear about the roles within the combined services for children -- not simply as single acting professionals. They also need high profile and influential advocates who have power............. With regard to transfer of employment to local authorities. The White Paper makes that very easy to do, in theory. Sir Nicholson, head of the NHS, commented yesterday that "Staff may also experience change in who they work for and the nature of their work". I do believe that school nursing and health visiting could be likely candidates for this. In fact, that was the case for school nursing from 1948 to 1974. And in some parts of the country, this is already on local authority agendas. However, there is a complicating factor here. I have looked at a number of Local Authority financial plans (out in the last month). Because the % cut in local authority budgets is so very large, it is the case that many are reducing staff numbers drastically -- first via not replacing vacancies and not replacing retirement posts. This first step will be followed by reductions in services and the Coalition has removed ring fencing from local authority budgets. This means that decisions about what can be cut are locally determined with considerable freedom. I just want to stop there but point out that the Public Health speech by Lansley does not mention that regulations on food and drinks manufacturers have been removed. Obesity, alcohol abuse, and smoking will not be regulated (e.g., food labelling requirements; increasing the taxes on alcohol and tobacco and such like). Instead the manufacturers will be given the task of discouraging people from buying their products! In summary, we will see a great diversity of interpretation and planning decisions across the country. Dr Sam Everington's description of a radical new concept of GP practice is a model of what we call "social capital"..................but there will not be incentives to transfer this model elsewhere. Indeed, he is describing a model of "social medicine" that is rare, innovative, and imaginative. But there is nothing I can see in the White Paper to encourage this to happen elsewhere -- apart, that is, from the rare leadership that places community above individuality, etc. The opportunity, therefore, is in the leadership SNs and HVs can support and provide that will mime this model at very local levels. I look forward to your responses. My intention is to find a way for us to understand the larger picture and how we can make a difference not only to workforce numbers but to workforce imagination. V best, Diane Cowleysarahcowley183@...http://myprofile.cos.com/S124021COn

[Guest guest]



Dear ,

Thank you for your thoughtful response. Indeed, the more we can track developments and analyse the trajectory (at local level and at the macro/trend level) the more effective we can be in finding ways to maximise the options for school nurses and health visitors rather than simply reacting.

One further thought -- the reduction of "managers" is a bit of a public relations "shot". Managers in the NHS are almost entirely senior practitioners/clinicians (not a cadre of separate staff from outside the NHS -- the vast majority come from careers in nursing, midwifery, health visiting, and doctors, allied medicine staff etc etc -- somehow the word "manager" -- by Labour as well as Coalition -- implies that these are not senior practitioners). Also, the Board and the new consortia could merely increase the numbers of "managers" according to my calculations.

It's tricky analysing the direction of travel...........thank you for providing a "hand-up" here,

Diane

Re: quity and excellence'

Dear Diane

Thank you for your thoughtful critique. HSJ are reporting (surprise!) that the White Paper has sent everyone into a spin as they worry about their jobs; well why wouldn't it?

I think you are right, that much of this is continuity with what went before (from New Labour as well as old Tory), much is about privatisation and balancing the books (especially all that talk of 'freeing up' foundation trusts so their finances don't appear in public spending totals) and much of the change was predicted. I even think there are some potentially positive elements about the plans but, as they say, the devil is in the detail.

I think the big question for health visitors and school nurses is where they will fall in this carve up of responsibilities:

1. Will their services will fall into the large pot that GPs have to commission (potentially not such a bad thing, as GPs generally know more about health visiting than PCT commissioners, but scary for those of us with bad memories of GP fundholding)

2. Will they fall under the same umbrella as GPs themselves, and be commissioned directly by the NHS board? Could be something to aim for, as at present the government is saying they want to commission more, but need to think about the long term.

3. Will they be seen as part of 'public health,' which I think is to be commissioned by the NHS Board but with far closer links to local government;

4. Or will they be seen as part of local government children's services? As you say, Diane, the problem then is the cost-cutting going on there.

I haven't been able to unravel that thinking from the paper yet, but perhaps all will become clear in due course.

best wishes

On 14 Jul 2010, at 14:09, Diane DeBell wrote:



Dear Colleagues,

I have returned from France and would like to add the policy perspectives I had promised a month ago. Apologies to everyone for the breadth of this "offering" and thanks to all for the documents shared on Senate.

The Coalition's White Paper on the NHS is only partly a suprise.

We knew from conversations before the election that this re-structuring was likely to be in the Conservative Party's planning for the NHS. Much of the new structure for the NHS is an extension of the approach implemented by the Conservatives during the 1980s/1990s (from 1984).

The abolition of both SHAs and PCTs was something we anticipated. The plan is to replace them by commissioning bodies that are much larger in number than the current # of PCTs -- individual GPs will not be commissioners. Consortia of (and on behalf of GPs) will take on the role of the previous PCTs. GPs will hand the commissioning role to managers in consortia. We can anticipate that some of these will be contracted from the private sector -- this is infrastructure management. It is a step toward de-centralization of the NHS and it is also a move towards a mixed economy NHS.

The likely scenario will also be a move to focus the NHS budget entirely on clinical needs and services.

Public health is a small and separate focus and could very well move to local authority responsibility and local authority employment packages. The Children's and Young People's Plans are already in statute and their Boards have responsibility for the kinds of health and social care that health visitors and school nurses provide. In addition, many were already moving away from employing Directors of Public Health before the election and have been conducting population health needs assessments in line with the statue required Joint Strategic Needs Assessments. All of this is simply to say that contracting individual services for children (such as HVs and SNs) will move to local decision making and local models led by partnerships of local public sector and voluntary bodies with some involvement of the private sector.

The point I am making first is that all guidance documents (e.g., the HCP [0-19]) are technically redundant. Only statute must be respected by a new government. All else can be ignored or changed by fiat.

Those of you who know my work will know that I have argued for many years that we need outcome measures rather than caseload measures in order to convince commissioners of the value of School Nursing and of Health Visiting. That is still true, indeed more so than ever. And with the new White Paper, the NHS is entirelly driven by outcomes. This is something that school nursing and health visiting have found it difficult to articulate with sound evidence.

There is not a response in the NHS to the "moral" arguments about providing good services for children and young people. Instead, the arguments that matter are political pressure and fiduciary. It is unlikely that "good work" cuts much ice nationally.

In addition, we are still in the position of trying to find ways of publicly describing the work of these staff. It simply isn't possible for the end user or the commissioner to "know" the complexity of school nursing and health visiting services without very sophisticated forms of public communication. We also need to be able to communicate the multi-purpose and multi-partnership work of these workforces. On the whole, most people outside the NHS (and many inside the NHS) simply don't know what HVs and SNs do. They have stereotypical "pictures" and they have "individual experiences" -- not sufficient arguments to persuade investment. This is a task of public communication and SNs and HVs need to be clear about the roles within the combined services for children -- not simply as single acting professionals.

They also need high profile and influential advocates who have power.............

With regard to transfer of employment to local authorities. The White Paper makes that very easy to do, in theory. Sir Nicholson, head of the NHS, commented yesterday that "Staff may also experience change in who they work for and the nature of their work". I do believe that school nursing and health visiting could be likely candidates for this. In fact, that was the case for school nursing from 1948 to 1974. And in some parts of the country, this is already on local authority agendas.

However, there is a complicating factor here. I have looked at a number of Local Authority financial plans (out in the last month). Because the % cut in local authority budgets is so very large, it is the case that many are reducing staff numbers drastically -- first via not replacing vacancies and not replacing retirement posts. This first step will be followed by reductions in services and the Coalition has removed ring fencing from local authority budgets. This means that decisions about what can be cut are locally determined with considerable freedom.

I just want to stop there but point out that the Public Health speech by Lansley does not mention that regulations on food and drinks manufacturers have been removed. Obesity, alcohol abuse, and smoking will not be regulated (e.g., food labelling requirements; increasing the taxes on alcohol and tobacco and such like). Instead the manufacturers will be given the task of discouraging people from buying their products!

In summary, we will see a great diversity of interpretation and planning decisions across the country. Dr Sam Everington's description of a radical new concept of GP practice is a model of what we call "social capital"..................but there will not be incentives to transfer this model elsewhere. Indeed, he is describing a model of "social medicine" that is rare, innovative, and imaginative. But there is nothing I can see in the White Paper to encourage this to happen elsewhere -- apart, that is, from the rare leadership that places community above individuality, etc.

The opportunity, therefore, is in the leadership SNs and HVs can support and provide that will mime this model at very local levels.

I look forward to your responses. My intention is to find a way for us to understand the larger picture and how we can make a difference not only to workforce numbers but to workforce imagination.

V best,

Diane

Cowley

sarahcowley183btinternet

http://myprofile.cos.com/S124021COn