Saturday, November 28, 2009

Who's bullying whom in the NHS?

More on better direction for NHS (see earlier post). Mike O'Brien, health minister, has described the kind of NHS manager that will be named and shamed (see HSJ article):

“It’s those who duck the difficult decisions, who hide in the quiet safety of their offices, or employ consultants to make decisions for them - who won’t put their heads above the parapet, not daring to engage staff and patients, putting off the inevitable for another day and not learning from others.

“These are the ones who should worry. But we will continue to support leaders and managers who show how we can deliver better care for patients”.

Managers are not used to this. They've even accused O'Brien of bullying them when he says he doesn't want them to slash and burn budgets. Managers have become more used to "top-down", centrally driven management, which could in itself become bullying when clinicians were not involved (see another previous post - Why do staff report high levels of bullying in the NHS?).

I guess the political stance must be gearing up for the election next year. It's about time Labour got it right on the NHS. O'Brien's speech even talks about looking at how a bigger proportion of budgets could be devolved to primary care trusts. This may not be that different from the Tory policy of giving GPs real budgets.

And anyway, clinicians have always said there needs to be better integration between primary and secondary care. I'm not saying that there wasn't a need to shift care from being too doctor-centred to more patient-centred, but the underming of professional values and opinions in doing this has been very damaging for the NHS.

Wednesday, November 25, 2009

New accountability framework required

The theme of a "call for evidence" by the Local Government Association (LGA) is liberating local public sector partners to serve local people rather than serving the machinery of Government.

For example, LGA has set an agenda for Ofsted, which says it should:

■be a voice of reason rather than feeding people’s fears
■be independent of external influence, basing its conclusions on facts and research
■use expert and knowledgeable inspectors who can offer advice and support
■assess how well children are being looked after and protected rather than measuring processes and procedures
■be focused on making services better rather than on delivering detached, public judgements

Barry Sherman MP, chair of the Children, School and Families select committee spoke out about Ofsted on BBC2's Daily Politics.

Better policy direction for NHS

Speech by health secretary to King's Fund spells out that the NHS for a fourth-term Labour government will be "preventative and people-centred, placing quality at the heart of all that it does". He also made clear that the NHS is moving on from top-down reform. "It led to a feeling that reform was imposed; done to people, rather than with them. It gave unintended messages at ward level – ‘public bad, private good’ – and process targets implied a lack of trust." He also recognised that "there is a danger that people in the service try to read the runes and conduct their own mini spending reviews".

The NHS chief executive took up the comment about the NHS as preferred provider and sent a letter to SHA and PCT chief executives. He again reiterated that "Service improvement and re-design should not be something which is imposed on NHS staff but something which they own and lead." The preferred provider policy has union support eg. as Mike Jackson from Unison says in a letter to the Guardian, "NHS services will not be improved by wholesale tendering, fragmentation and privatisation."

Sunday, November 22, 2009

Are medical professionals conscientious?

Article in Student BMJ about medical professionalism. It notes how professionalism is viewed differently by doctors, nurses and patients. A conscientiousness index has been proposed as a measure of professional behaviour in medical students.

This issue is complicated if medical students playing loud music or having a messy kitchen in halls are regarded as being unprofessional. In fact, doctors can be defensive about their income, style of practice, prestige, and power. It's actually the conscientious doctors that can be seen as different and difficult by their colleagues in this context.

The article mentions a roadshow to engage medical students in the issues round professionalism. This project by the King's Fund and others has already produced a report Understanding doctors.

Read Norman Lamb in Mail Online

Norman Lamb, MP for North Norfolk, has written about the Cawston Park fiasco (see my previous post) in Mail Online. I agree that it is important to get to the bottom of what happened to Andrew Breeze and Dominic Wilson. I still think there must have been envy (or similar) motivating the criminal prosecution. The background national scandal of shipping difficult to manage and place psychiatric patients out of the NHS into expensive private care barely figures in public statements about central NHS mental health policy thinking.

This isn't the first article that Norman Lamb has written for Mail Online. The other describes his successful investment in Tinchy Stryder via his son.

Sunday, November 15, 2009

Would you vote Tory because of James Murdoch and Rebecca Brooks?

Observer story about Father and Sun highlights how James Murdoch, Rupert's son, is steering the Sun, together with Rebecca Brooks, previous editor, and now CEO of News International.

There must be a question as to whether James can really step into Rupert's shoes. Rebecca Wade (as she was) has a lot to answer for in Sun campaign against Sharon Shoesmith, and previous misdemeanours as Sun editor.

Has David Cameron backed the right horses?

Tuesday, November 10, 2009

The Sun says Gordon Brown doesn't even know how to write his own name

The Sun says it's bloody shameful that the Prime Minister doesn't know how to spell his own name. Instead of putting Gordon, he's put Gorm. Instead of putting Brown, he's put Bum.

We do expect a Prime Minister to be able to dot the i's. And he shouldn't have to repeat the word "sincere".

It's serious that young British soldiers are dying in Afghanistan.