How to align social care with the NHS?

Chris Ham has another BMJ editorial. Setting the context of the debate about the NHS for the next election, he makes reference to the Barker report. A single, ring-fenced budget for health and social care, with a single commissioner is what is needed. However, it's not clear how to implement this as the report's recommendation 5 acknowledges:-

Our recommendation that there should be a single local commissioner for the new single budget does raise the question of who this should be. We have not had time to explore that in any detail, although, as we said in our interim report, a sterile debate should be avoided over whether health should take over the commissioning of social care or whether local authorities should commission the NHS. We do note however, that a number of others, including the House of Commons Health Select Committee, have said that over time the new health and wellbeing boards could evolve into a single commissioner for health and social care locally. That idea has its attractions. We recommend that work be undertaken to explore whether the health and wellbeing boards could evolve into the single commissioner for our new settlement.

AQP primary care psychological therapies finished?

Exclusive from the Health Service Journal is headlined "CCG interest in 'any qualified provider' scheme dwindles". As the article says, the AQP policy needed to be driven centrally. With no further mandatory requirements this isn't going to happen. And, the difficulty of managing contracts with potentially several providers hasn't been seen to be worth it. That's why I closed down Anglia Mental Health Community Interest Company (eg. see previous post), because it didn't seem likely it could get off the ground.

England depend on Alastair Cook

Is it a coincidence that England seem to do better when Alastair Cook at least scores a few runs? What they need to learn to do is win even if he gets out early.

Ed Balls should be held to account for Haringey's loss

According to the Daily Mail, Ed Balls shows no contrition for removing Sharon Shoesmith in the Baby P case. He doesn't seem to understand that the role of the politician is to avoid whipping up public scapegoating about child protection (see previous post). Read Ray Jones' The story of baby P for a balanced perspective on the case.

As Jones asks, why would anyone want to create such hostility and hatred against childcare professionals? Human beings do have the capacity for savage cruelty against defenceless children. I don't think Ed Balls is unintelligent and should be able to appreciate this.

Labour can't go into the next election with him as shadow chancellor because he clearly finds it too difficult to admit his mistakes about the economy (overspending leading up to the financial crisis) as well as Baby P.

Forward view for mental health services

Chris Ham analyses the impact of the new NHS England chief executive, Simon Stevens, in a BMJ editorial. Mental health would seem to be an obvious area for the development of population based budgets, where NHS Trusts, local authorities and CCGs take on responsibility together. NHS Trusts need to take on more of a role in leading improvements and commissioning alone will be insufficient. CCGs need to take responsibility for increasing referrals when there are current financial restraints.

Gove's discrimination against Muslims

By branding religious conservatism 'extremism' in Birmingham, ministers are making clear different rules apply to Muslims. Read Seumas Milne

The Rolf Harris dirty songbook

Now Rolf Harris has reminded us of Jake the Peg, let's not forget our amusement at the version of his Two Little Boys on "I'm Sorry I'll Read That Again" (see lyrics).

He looks weird, sounds weird and is weird

Why does me saying this about Farage not have as much effect as The Mail saying it about Miliband?

Science and the pharmaceutical industry

Fears about reduction of pharmaceutical R&D funding drive Lord Sainsbury, Chancellor of the University of Cambridge, to argue for blocking Pfizer's potential takeover of AstraZeneca (see Guardian article). He doesn't mention in the article that AstraZeneca had selected Cambridge Biomedical Campus as its new UK-based global research and development centre and corporate headquarters (see press release), which I guess may not happen, at least in the same way, if the takeover goes ahead.

What gets lost in this conflict of interest is whether R&D really leads to therapeutic advances (see Light & Lexchin, 2012). For example, most (80%) of the increase in drug expenditure in British Columbia between 1996 and 2003 was explained by the use of new, patented drug products that did not offer substantial improvements on less expensive alternatives available before 1990 (Morgan et al, 2005). 

Most new drugs are not superior on clinical measures and increase healthcare cost pressures. Medicine has always exploited the placebo effect. Pharmaceutical marketing is not always scientific (Applbaum, 2006). We may need less medicine not more (eg. see previous post).

What can I listen to on car radio?

Just had to listen to Gold via iPad app to make sure it was still there (but without presenters) as could only get Smooth on car radio today - see why. Why change my habit?

Reduce drugs we give people in NHS

The Guardian gives over its front page to an interview with the retiring NHS chief executive, who in my opinion should have resigned in 2009 (see previous post). He argues for an extra change fund to switch hospital to community based care. There is clearly scope for this to happen, but it does need a properly based philosophy of care to underpin it. Actually, what we need as a society is less medicine not more (see another previous post). This means doing what he says we should not do, which is reduce the drugs we give to people.

And there's nothing wrong with serious A&E cases being centralised in major emergency centres, but that's a relatively minor issue compared to providing effective alternatives to admission to hospital. And one of the biggest mistakes would be to dismantle the primary care system we have in this country, which is envied by others, even if it has lost its way a bit with countless NHS managerial reforms. And of course we do still need acute hospitals.

Update on previous post

Even the NHS is supported by the drug companies

Why is Janssen supporting the 2014 Mental Health Network Annual Conference? The Mental Health Network was established by the NHS Confederation, the membership body for all organisations that commission and provide NHS services, to "provide a distinct voice for mental health and learning disability service providers". It is supposed to speak on behalf of the whole NHS, so I'd have thought it didn't need pharmaceutical company money to do that.

The cost of the Guardian

I've been moaning about the Guardian costing £1.60. Today I was charged £1.20 when scanned in the shop even though the paper still has £1.60 on the front!

Blog resistance

Hey, now I know why I blog! See Howard Caygill's Digital Resistance. Blogging "... plays a significant role in delegitimising domination by making it available for scrutiny and comment from a variety of perspectives, potentially contesting the tendency towards monopolization of information, wealth, power and ultimately violence essential to legal rational or even total domination".

The "spectre" of Savile

CockRoache has been found not guilty. Reinforces the case for a public inquiry (see previous post).

Kev, stop tweeting!

Whatever the hurt pride, I can't see that Kevin Pietersen tweeting "I'm shocked and saddened by reports in the media today concerning my future with England ... " has helped his case. Even with Michael Vaughan's support (see Telegraph article), his difference with Andy Flower is something that needs to be sorted out in private, not in the media (which includes Twitter) following the Mail's report. I'm sure Pietersen doesn't mean to bring the England team into disrepute but there's nothing to be gained by 'fanning the flames' in public.

As I said in a previous post, resolving difficulties with Pietersen has not been easy. After all, it was Alastair Cook that facilitated Pietersen's reintegration after the last fiasco. As I pointed out in my tweet, Shane Warne took full advantage of this before the Ashes, encouraging the sledging on the field. As England fall further down the rankings from their peak in 2011 (see previous post), it's important that Pietersen is not made a scapegoat. But the England team is more important than his ego. He shouldn't need to state his desire to help regain the Ashes for England. It should go without saying.