Andrew Craig's Comments
Comment on: Nicholson seeks "legitimacy" amidst a storm of protest
Forget "grip", this is about "blood and iron" but sealed with a Glasgow kiss. But Bismarck got dropped too don't forget.
Comment on: A perfect storm of NHS scrutiny
Better brush up on the Smart Guide to working with Local Authority scrutiny then www.networks.nhs.uk/nhs-networks/smart-guides/documents/Working%20with%20local%20authority%20scrutiny.pdf
Comment on: CCG "progress" to be judged on 35 measures
PCT deja vu. After 10 years lashed to the mast of our PEC, it all seems to be steering round in a circle again and with a lot less dosh to go round. When the CCG leaders realise what "grip" really means, many will be very unhappy with their "liberation". They will be so busy looking up at the CB (or their LAT) that they won't have much time to look out and talk to their communities about the really tough decisions they need to make together and without delay.
Comment on: HSJ100 2012: Under 'Baron' Nicholson, a new health aristocracy takes shape
Alastair I think the whole tone of this is unfortunate. Barons and aristos is most definitely NOT what the NHS needs now. Turf wars and power struggles have got us into much of the mire we currently see. We need leadership to get out of it, and that has to come from the front line, grass roots or whatever else you want to call it. The job of the "aristos" is not to get in the way.
Comment on: The 17 most influential health leaders on Twitter
I will take Roy Lilley over many of these any day for insight into what's really going on. And witty too.
Comment on: CCGs face old fears with desire for change
It's great to learn that CCG leaders are enthusiastic for integration. But who is meant to benefit from integration? Nut just commissioners and providers. What service users want is coordination and continuity of services. Whether they are “integrated” or not is less important than how they are received and their responsiveness. So the question is “integration for whose benefit?” If done for the "wrong" reasons and without user and carer engagement from the outsest, Integration could be anti-competitive and anti-user and carer choice. Integration makes good sense for people with complex needs and for those using health and social care (old people, long term conditions, kids) – so vertical and horizontal across services is needed. The biggest problem is that we don’t have enough practitioners who think and work like that. So just changing structures will not do much good, even if it is possible and affordable. Of course, doing nothing is also not affordable. Changing professional attitudes and practice to commission and deliver coordination from a user perspective requires leadership and persuasion, not just initial enthusiasm.
Comment on: Exclusive: CCG leaders favour integration over competition
Lots of interesting stuff here (and in the full Excel verions of the Barometer), but look as I might I could find nothing in the questions or the responses - please tell me that I have missed it? - about engagement with patients, carers and communities, building public support for change (eg decommissioning) and community development and capacity building to enable collective shared decision making. If those things don't happen, CCGs won't be the only people left whistling in a very chill wind indeed.
Comment on: Revalidation cannot be left to GMC alone
Revalidation can’t all be piled on the individuals and the registration bodies are not the right ones to lead it. For the bulk of doctors (and nurses, and therapists – all clinical roles) a big part of the answer is that their employers should do this and be held to account for doing it well through a licensing system on institutions and all other organisations which deliver healthcare. For clinical contractors, meaning the bulk of GPs – who are self employed don’t forget – there is no substitute for a peer review process. The people who know best about good and poor medical performance are the local GPs in the CCG. I believe that they should deal with assessment, remediation and rooting out failure as part of the CCG’s own reputation management and clinical governance processes. And they should be held to account by the Commissioning Board for doing this well. No matter where it happens, the process has to have a strong and meaningful patient (customer) input. That’s the challenge we need to put to the new revalidation system. Let’s hope the evidence shows that it can deliver what we all hope for it.
Comment on: Scepticism remains following green light for revalidation
Unless we are careful, this could create a compliance treadmill that may turn out to be loathed for the time it diverts from patient care. It is meant to start before the end of this year with medical leaders. This means the very GP leaders we need to be putting all their energies into the new CCG commissioning system which kicks off in April 2013 will now have to divert time and attention to jumping through Mr Hunt’s new hoop. David Nicholson warned only a few days ago that if we get the CCG implementation wrong, the whole thing will end in “misery and failure”. I do not want him to be proved right and this could increase the risks. Mr Hunt’s announcement about revalidation for doctors comes only days after he announced at the Tory Conference that he wants the CQC to license individual managers and hold them to account for safe and effective care in the institutions they run. This helps turn the NHS into a regulatory monster. It won’t make things better and could make them worse. Piling everything on to individuals will still allow organisations to behave badly and dangerously. Perhaps we should license health ministers next?
Comment on: In full: CCG leader names
This is a good start towards compiling what will turn into a key resource, so thanks HSJ for taking the lead. Future iterations will include Lay Members for PPI and governance on CCG Boards - won't they?
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