Best of the frontline bloggers (week ending 2nd November 2012)

We love public and voluntary service bloggers. At their best, they capture the day-to-day reality of public services in a way that Westminster-commentators can’t – and they have the real expertise and insights we need to improve social policy. Here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Social care

Is there any way to improve?

From How Not to Do Social Work

Posted on 31st October 2012

“So today when I was asked the question is there any way to improve? the answer was Yes, talk to Social Workers, understand what the difficulties are in social work and where the learning is needed to develop practise including investing in social work and acknowledging that specialist knowledge is learned over a long period of time not over a fancy title.”

How Not to Do Social Work, an experienced social worker, reflects on many years of discussions about how to improve social work for children’s services, and especially the difficulty of dealing with what is still the biggest issue: defining what a vulnerable child is and at what point intervention is needed.

Education

Sorry you got a C… No Sixth Form for you!

From The 99% Blog

Posted on 1st November 2012

“I suppose all we can do is wait and hope for errors to be put right as they should be. If this works then yippee, if however it doesn’t, then we as a collective; the generation of a new age, need to establish a way for us to voice our opinion and succeed in omitting errors in society that affect us and others.”

Aaron challenges the unfairness of the GCSE exam re-grading fiasco and how it has damaged the aspirations of thousands of young people, but notes the possibility of “one last shot at justice…”

Why all teachers agree with David Laws

From Pedagoggles

Posted on 26th October 2012

“Teachers refuse to work longer than the 9-3, and as we know, those six hours are dedicated to the systematic beheading of every child’s hopes for the future.”

Good news for the Government (or possibly not), as one teacher agrees with David Laws’ recent comments about the profession fostering ‘depressingly low expectations.’

Health

More wisdom from those who think that NHS IT has landed on the moon

From Northern Doc

Posted on 1st November 2012

“…when someone who works for an organization called the NCB tells you that they are “pushing for the end of 2015 to eradicate paper from the NHS” you can bet the smart money will be buying shares in paper manufacturers.”

Northern Doc shares his doubts about the ‘next big thing in NHS IT’ – or “hugely expensive white elephant”, depending on where you stand.

Time for an update

From Life in the NHS

Posted on 28th October 2012

“I predict that once the dust has settled and the ‘bureaucracy’ has been removed, some people will be very shocked by what is left. They will be surprised that the NHS isn’t actually being run by GPs (though they have a wonderful nominal role) but by rehashed senior managers some of whom work in Leeds and many more work out in the local areas.”

A welcome return to the blogosphere to a ‘nurse, manager, wife and mum’ – and a warning about the coming chaos in a changing NHS.

Policing

Backwards to the future – A scientific(ish) experiment

From PC Bobby McPeel

Posted on 30th October 2012

“Ok, this is probably the least scientific experiment in the history of science, and I’m sure someone much more intelligent than me would tear it apart. However, I wasn’t really trying to be scientific. I am trying to make a serious point that these piecemeal police reforms that fail to recognise the unique nature of policing…”

PC McPeel (“proud to be a pleb”) does some rough maths on the Winsor reforms to see the effect on police numbers – and finds they don’t add up.

Justice

To hurt or to heal

From Ben’s Prison Blog – Lifer On The Loose

Posted on 30th October 2012

“Criminals grow up in communities, they live in them and they then harm them. It is in communities that our best chance of reclaiming people lays. To shrug off our difficult members and hide them behind high walls is short sighted, expensive, and ultimately futile.”

Previously known as “one of Britain’s best known prisoners”, PrisonerBen challenges the policy focus on prison and instead proposes a community-based alternative.

Can the Tories – or any government – be trusted with human rights?

From Jailhouselawyer’s Blog

Posted on 29th October 2012

“See, if you’re David Cameron, prisoner votes are as close to a perfect policy as you’re likely to find. Opposing them makes him look like he’s finally getting tough on the ‘faceless Belgian bureaucrats’ and ‘unelected judges’ who think they can boss us about, which looks great in front of the wing of his party mostly comprised of the elderly and mildly xenophobic. …While this might make for a calming influence in the party, and an easy news cycle for Grayling, what it amounts to is a defence of widespread disenfranchisement.”

John Hirst argues that withholding the right to vote from prisoners is really a matter of fundamental human rights, not about Europe.

If you’re a frontline blogger, do send us your latest blogs on policy issues or posts from the past that you’re particularly proud of, and they could be included in next week’s round-up. Get in touch with us at: info@guerillapolicy.org or via Twitter @guerillapolicy and @guerrillapolicy


The Government is paying the political price for the lack of open policymaking in its reforms to the NHS

The NHS is facing significant financial pressure as a result of austerity with smaller increases in spending, which are not keeping pace with demand. This has meant that the NHS has to find £20 billion in efficiency savings by 2015. At the same time the health service is facing one of its biggest upheavals ever, which will result in a greater involvement of private companies in the health services. The reforms to the NHS have been introduced in the face of stiff opposition and in many ways represent the opposite to open policymaking – and the Government is now paying the political price.

The opposition to the Health and Social Care Bill was substantial and included the majority of the main health bodies, many of whom were not invited to attend the infamous Downing Street health summit to discuss the bill earlier in the year. Notable non-attendees included:

  • British Medical Association
  • Royal College of GPs
  • Royal College of Midwives
  • Royal College of Nursing
  • Chartered Society of Physiotherapists
  • Royal College of Pathologists
  • Royal College of Radiologists
  • Royal College of Psychiatrists
  • Unite
  • Unison.

Opposition to the bill was widespread in the workforce of the health service. One survey found overwhelming opposition from hospital doctors, with 9 out of 10 professionals opposed to the bill. Strong opposition to the reforms was also apparent amongst the grassroots of the coalition parties. ConservativeHome came out in opposition to the reforms, arguing that it could cost the Conservatives the next election and would distract from important reforms to welfare and education, whilst Liberal Democrat party members opposed the reforms by 2 to 1.

Much of the opposition about the reforms has centred on how complex and fragmented the new health system will be. Clare Gerada, Chair of the Royal College of GPs, has argued that the move to a market-driven health care system will result in a culture of ‘my disease is more important than your disease’, with GPs at the centre of this trying to balance these competing voices. She has flagged her concerns about the lack of experience of GPs in managing relationships with the charities and lobbyists they will face when commissioning in future.

Andy Burnham, the Shadow Health Secretary, agrees on the point of fragmentation of health care, arguing that “my answer is simple: markets deliver fragmentation; the future demands integration.” He has called for a single system for health and social care which addresses the physical, mental and social needs of the nation. He has argued that central government should decide what health services should be delivered and local government how.

Despite the overwhelming opposition, ministers have been happy to write off the protests as ‘business as usual’ when it comes to NHS reform. Simon Burns, the then Health Minister, stated that the opposition from these ‘vested interests’ was to be expected and scare stories about ‘creeping privatization’ are par for the course. Andrew Lansley, the former Health Secretary and architect of the reforms, argued that the Royal College of Nursing only opposed the reforms because of pension changes, accusing them of being ‘a vested interest indulging in trade union -like behaviour’. The appointment of Jeremy Hunt as the new Health Secretary does not inspire hope about a change of policy course, given that he is seen as a proponent of greater involvement of the private sector in a market-driven health service.

The reforms have now received Royal Assent and the Government seems committed to accelerating the involvement of the private sector in the NHS. Research by the Labour Party using freedom of information requests to NHS primary care trusts found that contracts for almost 400 NHS services worth a quarter of billion pounds were signed in early October, representing the biggest act of privatization ever seen in the NHS. The research found that in a quarter of cases, the primary care trust had not been open about its intention to outsource, resulting in a considerable amount of privatisation by stealth.

The biggest privatisations so far have been in community services – those healthcare services offered outside of hospitals including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children and primary care psychological therapies for adults. Children’s health care in Devon is now delivered by Virgin Care, as are GP services in Northampton and sexual health services in Teeside. This week’s Channel 4 Dispatches programme entitled ‘Getting Rich on the NHS’ uncovered poor quality services delivered by Virgin Care and concerns from local residents that their local services have been privatised often with little or no involvement from the community in this decision.

Paul Corrigan, the former Labour health adviser, argued in September that outsourcing of services should go further. He proposed that the private sector should be allowed a greater role in the NHS to ‘save’ failing hospitals. This argument is ironic given that this week it became apparent that the flagship outsourcing of Hinchingbrooke Hospital in Cambridgeshire to the Circle Partnership is not delivering on the initial expectations. The hospital, in private hands, has racked up losses of £4.1 million in the first six months of the contract – £2 million more than was expected. Given that the private sector was involved to save the hospital from financial ruin, the experience so far does not bode well.

This closed approach to policymaking and reform is having a real and significant political impact on the Government. A recent survey by IpsosMORI on which party has the best policies on healthcare found that the Conservative’s ratings are at pre-Cameron levels. Only 16% of voters believe that the Conservatives have the best policies on healthcare and they seem to have lost the battle in convincing the public that the NHS is safe in Tory hands. A further recent poll by IpsosMORI points to a re-toxification of the Conservative brand, with a sharp increase in people who don’t like the Tories since they came into government, which the reforms to the NHS are clearly a part of. The Government is paying the political price for the lack of open policymaking in its reforms to the NHS.


Best of the frontline bloggers (week ending 19th October 2012)

We love public and voluntary service bloggers. At their best, they capture the day-to-day reality of public services in a way that Westminster-commentators can’t – and they have the real expertise and insights we need to improve social policy. Here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Social care

What I would say to Norman Lamb

From Ermintrude2

Posted on 18th October 2012

“What I see are cuts. I see respite narrowing in terms of ability to access. I see provisions which had been helpful, closing. I see a lack of beds in the local hospitals when they are needed and I see people who need support being denied it because there are no provisions left. So take your pleasantries and policy ideas and come and spend a day with me in the community and you’ll see why I am impatient and unbelieving about the platitudes that emerge from those who don’t seem to understand what is happening ‘out there’.”

Ermintrude, who works in dementia services, speculates on what she would say if she had the opportunity to meet with Norman Lamb, the new Liberal Democrat Social Care Minister. She argues that those in positions of power – be it Ministers of Senior Managers – need to take responsibility for their policies by listening to those who work at the frontline and are responsible for putting these policies into practice.

Not the Francis report

From Whose Shoes?

Posted on 17th October 2012

“Life can often only be understood backwards, but it must be lived forwards.It is important and necessary to look back and understand what went wrong in Mid Staffordshire and ensure that the voices of those affected have been adequately heard. But it is also vital that we now look forward and learn the lessons to create a system in which poor quality and unsafe care can no longer be ignored.”

A guest post by Laura Robinson, Policy & Communications Advisor for National Voices, raises fundamental issues around patient care and patient safety, following the independent inquiry in Mid Staffordshire. There is already much collective wisdom and widespread consensus on what needs to be done to ensure that care is safe, effective and responsive to patients’ needs. ‘Not the Francis report’, published by National Voices this week, brings this together in a series of recommendations and urges the Government and NHS leaders to drive forward improvements across the whole system of health and social care.

Lead like lambs into his hands: Is light entertainment more important than child protection?

From Secret Social Worker’s Blog

Posted on 12th October 2012

“Child protection can never be a matter for just professionals but instead must be a concern for the whole community. Those who see or know about the sexual abuse of children should have little doubt about its destructive outcome and how utterly wrong it is. Therefore there can be few excuses for allowing it to continue. There is ALWAYS something you can do.”

In this post the Secret Social Worker argues that the Savile scandal reminds us that child protection is the responsibility of the whole community, not just statutory agencies.

Social workers have a duty to join Saturday’s anti-austerity march

From the Social Work Blog

Posted on18th October 2012

“David Cameron can tell us that “we’re all in this together”, but as social workers we know this couldn’t be further from the truth.”

Lizzie Furber, a social worker and member of the Social Work Action Network, argues that social workers are in the frontline when it comes to seeing the impact of cuts. Lizzie issues a call to action for all social workers to take part in the anti-austerity march taking place in London on Saturday 20th October. She argues that cuts affect all areas of social work, with caseloads soaring.

Health

“Return the money” – is spending less on healthcare the moral thing to do?

From @micmac650

Posted on 18th October 2012

“For me this has been crystallised by the impending Scottish independence referendum. Soon we may be making the decisions about our own country – what balance of expenditures will give us the healthiest and happiest population? I’m fairly confident that diverting money from nuclear missiles to healthcare would be a good thing. But how do we balance the competing demands of a universal high speed broadband network or higher teacher-pupil ratios?”

Mark MacGregor (@micmac650) is an Associate Medical Director and consultant nephrologist in NHS Ayrshire & Arran. He is also a Health Foundation fellow. In this post he argues that clinicians need to put the days of campaigning for more resources behind them, and instead devote energies into addressing the ‘health productivity challenge’ – how do we maximise health gains within existing resources?

Democracy

From Dr Grumble

Posted on 14th October 2012

“I have never really thought that I live in a true democracy. The world’s oldest democracy is just a stock phrase I trotted out. It probably stems from the ruling classes intent on giving us plebs the illusion that we have some control over our lives. We don’t. Not much anyway.”

Dr Grumble describes how a threat of a hospital closure is being pushed through with little engagement of both GPs and consultants. The Chief Executive of the hospital states that ‘the hospital was not a democracy. It’s not. It never has been and it never will.’ Dr Grumble describes how people have been invited to take part in a formal consultation, but laments that ‘formal consultation processes are more about telling the populace what is going to happen than listening to their concerns.’

Policing

@craig2383 meets the Home Secretary

From Nathan Constable

Posted on 14th October 2012

“I told her that if she wants to make the Police political then this reg needs to go. Her response was that the Police wont be political but rather run by a democratically elected person. However I then told her that we as the Police can’t be part of that as either as Police or public as regs still governs our behavior in our personal life. I told her that we can’t publicly support any candidate in any way or even stand for election. This means that there is a direct conflict with the PCC process and the very core of Police regs. Its almost like this was a completely new thing to her.”

@craig2383 has spoken to his MP about Police Reform. It just so happens that his MP is none other than Home Secretary Theresa May. Craig shares his account of the meeting via Nathan’s blog. In the post, Craig shows the limits of May’s knowledge of the reforms that her Government is pushing through. He also points out the tension between politicisation of the police service and the rules governing police officers’ political activities.

Education

Mixed ability

From Frank Chalk

Posted on 16th October 2012

“Let’s not pretend or mince our words here – Miss Jones is simply wasting Brandon, Lee and Edward’s time. It’s not her fault – she is only human and cannot possibly deal with such a ridiculously large spectrum of abilities. Deep down, she feels that mixed ability classes seem to let down the best and the worst. All she has ever been told however, is how great it is that the school is so ‘inclusive’.”

In this post, Frank Chalk points out the challenges for teachers in meeting the needs of a diverse range of students in mixed ability classes. He argues that the system is failing higher achieving pupils and those who require more support.

Previous reads

Here’s another great post published in the last few weeks.

Taking comms back to basics

From Carolyne Mitchell

Posted on 4th October 2012

“This is comms 1.0. It’s about getting back to basics and thinking about the way we communicate with the public directly, not through the media. It’s about plain English, cutting through the crap, getting to the point and making it as easy as possible to deal with the council.”

Inspired in part by the Government’s Behavioural Insights Team, Carolyne Mitchell, a communications officer at South Lanarkshire Council, considers how local government comms needs to be less about press releases and more about changing public behaviours.

If you’re a frontline blogger, do send us your latest blogs on policy issues or posts from the past that you’re particularly proud of, and they could be included in next week’s round-up. Get in touch with us at: info@guerillapolicy.org or via Twitter @guerillapolicy and @guerrillapolicy


Best of the frontline bloggers (week ending 12th October 2012)

We love public and voluntary service bloggers. At their best, they capture the day-to-day reality of public services in a way that Westminster-commentators can’t – and they have the real expertise and insights we need to improve social policy. Here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Welfare

Cutting housing benefit for under 25s is indefensible, immoral and criminal

From DrTimCB

Posted 10th October 2012

This week George Osborne outlined plans to slash housing benefit for people under the age of 25 in both his conference speech and a Daily Mail article. This is part of a wider £10bn cut to the welfare bill… I’m presuming the subtext here is that if you’ve never paid into the system, you shouldn’t be able to take anything out. This shows such a profound lack of insight into the lives of many young people in the UK.”

Dr Tim, a junior doctor working in Tower Hamlets, tells the story of three young people – Max (19), Bea (22), and Nelufa (19) –  that he has worked with and who would lose out if proposals to reduce eligibility for housing benefit for those aged under 25 announced this week become reality. He argues that these reforms would leave vulnerable young people like these destitute, homeless and isolated.

Ruth Anim and Liam Barker – Different Disabilities, Very Similar Situations

From Same Difference

Posted 6th October 2012

“Exactly two weeks ago today, I heard and wrote about the case of Liam Barker. Eighteen years old, paralysed since birth, he breathes through a ventilator. His parents had just received a letter informing them that in order to receive Employment Support Allowance, he might have to prove he is unable to work by attending a Work Capability Assessment.”

In this post Same Difference describes the experiences of two disabled people with complex needs, Ruth Anim and Liam Barker, who have been subjected to the Atos-managed Work Capability Assessment (WCA). Liam has received a letter informing him that he will need to undergo a WCA, while Ruth’s mother has successfully appealed the findings of her daughters WCA which found that she was fit for work.

Health

Medical power

From Abetternhs’s blog

Posted 5th October 2012

“I have written this because like many, perhaps most GPs I feel very uneasy about power. I aspire to a partnership with my patients, teamwork with my fellow health professionals and a more equal society. I feel very strongly that power is a privilege and medicine is a vocation and a public service, or as Iona Heath recently described it, ‘a labour of love’. Usually medical power is viewed in negative terms, an unreasonable acquisition of privilege and abuse of patient trust and public respect for personal gain. Whilst I don’t deny that medical power is abused terribly in this way, I am concerned that power is shifting away from professionals and democratically accountable government, and I am not sure that this is in our patients’ best interests…”

GP Jonathon Tomlinson challenges the current orthodoxy in healthcare by considering the implications of the power that healthcare professionals hold.  He argues that notions such as ‘patient independence’, ‘self-care’ as well as regulation and outsourcing, are reducing the autonomy of healthcare professionals and disempowering patients. He speculates about what this could mean for the future of healthcare.

High sounding words but privatisation marches on

From Mike Broad, on Hospital Dr’s Dr Blogs

Posted 9th October 2012

“Don’t get me wrong. I’m not blaming the private providers – indeed I’m not against the use of the private sector under certain circumstances. They’re not snatching these cherries, they’re being offered them by commissioners desperate to reduce costs.”

Mike Broad argues that the Government is rushing to privatise parts of the NHS to ensure that its reforms can’t be unpicked by any future incoming Labour administration. He outlines his concerns that the Government is not sufficiently addressing the risk that the private sector will cherry pick the most lucrative procedures under the policy of payment by results in health.

Policing

The Real Big Society

From PC Bloggs

Posted 5th October 2012

“Reading media reaction to Hillsborough, to Ian Tomlinson’s death, to all the other negative news stories, is galling at a time when we also feel let down by our own management and the Home Office. I am sure many police officers up and down the country have been wondering just what we are doing it for.” 

PC Bloggs describes how the outpouring of grief in the wake of the untimely deaths of PCs Fiona Bone and Nicola Hughes has brought hope that the police service still commands public support in the wake of cuts and negative news stories. PC Bloggs argues that Big Society isn’t a replacement for public services, and that recent events point to a very different relationship where public professionals are valued and respected for the contribution they make.

Criminal justice

Cry From The Heart

From The Magistrates’ Blog

Posted 9th October

“Off to court yesterday morning. Standard kind of court list, three CPS trials listed, 2 in the morning, 1 in the afternoon. The subject of the charges also pretty usual, a couple of Assault by beatings (Common Assault) with domestic violence overtones and a Harassment without violence. In we go at 10 am all fired up having had some Case Management Training on Saturday…sadly it all went downhill from there.”

Bystander J, posting on the Magistrates’ Blog, describes three cases where the trials could not proceed because of bureaucratic barriers and lack of joined-up working between the courts and the Crown Prosecution Service.

Mental health

On Northern Ireland Backing the WRB and David Cameron’s cpc12 ‘Aspiration Nation’ Rhetoric

From The World of Mentalists

Posted 11th October 2012

“This idea that claiming benefits is a lifestyle choice is as hilariously preposterous as it is bullshit. Who would even entertain the notion of choosing this ‘lifestyle’? It’s a horrid way to go through everyday existence, as I can wholeheartedly assure naysayers. …Are there scroungers out there? Yes. Do they need weeded out of the system? Yes. Of course they do. But not at the expense of the vast majority that claim due to genuine illness. And it is a majority.”

To mark the passing of the Welfare Reform Bill by the Northern Ireland Assembly, The World of Mentalists spends the day listening to David Cameron’s speech day “in a state of raw terror [and] guzzling diazepam” – but at least it produces a good rant.

If you’re a frontline blogger, do send us your latest blogs on policy issues or posts from the past that you’re particularly proud of, and they could be included in next week’s round-up. Get in touch with us at: info@guerillapolicy.org or via Twitter @guerillapolicy and @guerrillapolicy


Open policymaking: Should there be a ‘duty to involve’ for national policy?

As Edward Andersson from Involve noted in his recent blog reviewing the new consultation principles issued by government: “Today consultation has, for many citizens, become a byword for formalistic, tick box exercises, done to mask a decision which is already a ‘done deal’.” Edward rightly suggested that the new principles, while important, fall short of providing the solution to this widely shared view of consultation. Could one solution be a national ‘duty to involve’, similar to the requirement that some local public services are already subject to? In which case, national policymakers should look to their local counterparts for what works.

This post is part of the project on open policymaking and better consultation, hosted by the Democratic Society in association with the Cabinet Office. As Anthony Zacharzewski, head of DemSoc, has summarised it: “Open policymaking is the natural corollary of open data and transparency, requiring openness and allowing public participation at every stage of decision-making and implementation. It supports citizen action and positive involvement of the public in shaping laws and services.” This active engagement is obviously very different in scope and ambition to traditional consultation, but this doesn’t mean we’re starting from scratch. If, as the Government has said, in the future “all policies will be made openly”, we could learn from where there have already been attempts to achieve a different, more deliberative approach to decision-making – in local government and local public services.

Many of these local duties to involve citizens have been introduced through national policy. For example, Section 138 of the Local Government and Public Involvement in Health Act 2007 imposed a duty on all councils and ‘best value’ authorities to involve ‘local representatives’ when carrying out functions by providing information, consulting or ‘involving in another way’. Councils must engage with a balanced selection of the individuals, groups, businesses or organisations the council considers likely to be affected by, or have an interest in, the council’s functions (including children and young people as appropriate). For the National Health Service, legislation which came into force in 2003 placed a duty on certain organisations to involve and consult, but managers were not always clear when they had to involve people or how it was best to do this. The 2007 act aimed to make this clearer; the duty requires NHS organisations to involve users of services in the planning and provision of services, the development and consideration of proposals for changes in the way services are provided, and decisions affecting the operation of services. Section 242 of the earlier consolidated NHS Act 2006 was also supported by useful guidance on achieving ‘Real Involvement‘ from service users and communities.

The NHS’s operating framework further emphasised that this engagement should be ongoing, not just during periods of change. Primary Care Trusts and NHS providers should “…create greater opportunities for their communities to make their voices heard, raising awareness of those opportunities and empowering patients and the public to use them and LINks [Local Involvement Networks]; [and] take greater responsibility for communicating with their local populations and stakeholders to ensure better understanding of, and confidence in, local NHS services.” More recently, the NHS constitution underlines that public and user involvement should be part of the fabric of the NHS: “You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.”

The reality of local engagement might only rarely meet these ambitions, and many local policymakers, managers and clinicians might question the extent to which the public can play a constructive part in decisions on reconfiguring clinical services. Views on the success of local LINks vary widely, and they are due to be replaced by Local Healthwatch organisations in April 2013 as part of the ‘new NHS’. But this gap between aspiration and reality may be more a matter of developing and using the right methods for engagement – and being seen by local communities to be making genuine efforts at this engagement – rather than a fundamental problem with the aspiration itself (these are after all public services, paid for by the public, and they should surely be accountable as such).

Organisations such as Involve (a partner in this discussion) have a wealth of experience about what works locally (Edward referenced some very useful resources in his blog) – surely some of these principles and practices could not only be better shared locally, but applied to national policy as well? As we’ve noted before, one of the reasons that the Government’s NHS reforms ran into such difficulty was the view held by stakeholders that the policy was developed in a fundamentally closed way rather than constructively and collaboratively. The Government says that empowering individual patients and increasing the local accountability of health services is at the core of its reforms; shouldn’t we apply the same principles of empowerment and accountability to the development of health policy as well as the operation of health services – and to any policy for that matter?

The Government’s Civil Service Reform Plan, where its committment to open policy was announced, makes no reference to existing local methods of engagement and how these could inform open policymaking at a national level. Nonetheless, national policymakers should look to the methods that have been used by local policymakers and planners to engage their communities and service users in decision-making – both the successes and the failures – and consider how the most effective approaches could be adopted and adapted for national policy. Open policy is an ambitious agenda. Making it real will require effective methods for engagement, but also ways of requiring that policymakers develop policy openly. As well as learning from local methods of engagement, do we need an equivalent national ‘duty to involve’ stakeholders in policy development?


Best of the frontline bloggers (week ending 21st September 2012)

We love public and voluntary service bloggers. At their best, they capture the day-to-day reality of public services in a way that Westminster-commentators can’t  and they have the real expertise and insights we need to improve social policy. Here’s our selection of the best frontline blogs we’ve read this week. Do send us your suggestions for great posts we’ve missed – and those frontline bloggers we should follow in the future.

Health

A rare shaft of light

From The Jobbing Doctor

Posted on 15th September 2012

“Anna Soubry, the new junior minister at the Department [of Health], is reported to say that the Government screwed up by not engaging with the professions. She is right, although they never really intended to win hearts and minds: we are not idiots and could always see what was planned. This comment is a shaft of light in the murk of the plotting to break up the NHS.”

The Jobbing Doctor, a GP working in a large industrialised conurbation outside London, argues that the Government health reforms are not about empowering the professions but a detailed and planned assault on the service – supported by all the main political parties and a ‘tiny list of supporters’ to provide cover.

Education

A new summing-up

From Scenes from the Battleground

Posted on 16th September 2012

“The central contention of this blog is that our state school system is simply not good enough. It does not provide a decent quality of education for the vast majority, and most would avoid it if they could afford to. Too many people with power over education are content to provide a service that they would not think good enough for their own children.”

A dumbed-down curriculum and teaching methods, the ‘behaviour crisis’, and bureaucratic and incompetent management: the problems facing the education system as described by an ‘utterly dissatisfied’ secondary school teacher – and what the future holds.

Social care

Consulting on the CQC

From The Not So Big Society

Posted on 20th September 2012

“For a regulator to have public confidence, the public have to know what they do, what they are responsible for and what they are not responsible for. …Inspectors could have a greater visibility online and using broader social media to communicate with the public – not just through PR people. I want to know what inspectors do every day. I’d love to see a regular blog from an inspector (without needing to mention any specific services but just with broad themes – generally frontline blogs are more interesting than management blogs!)”

Ermintrude, a ‘social worker by trade but so much more’, reviews the new draft strategy for the health and adult social care services regulator the Care Quality Commission – and argues for a much more people-based approach.

Disability

Care is care. Let’s stand together for political and social change

From The Caregivers’ Living Room

Posted on 19th September 2012

“The thing is …we are all sitting around here talking about big ideas like nurturing leadership in our disabled youth population and whether we should lobby for more disability arts initiatives. What I think we should talk about is whether in ten years time, there will be anyone around to wipe our bums. I believe we are heading toward a time when giving care will be devalued and we will all end up being warehoused in institutions with lousy care and no one will notice.”

Donna Thomson, former actor, director and teacher, now parent to a disabled son and with a ‘second career’ as a disability activist, reflects on the challenge she once heard in a meeting of activists – and the need to think like a movement in order to achieve political and social change for the good of families and the future.

A perfect storm

From Welsh Wallace

Posted on 17th September 2012

“…according to the new test for the benefits I wasn’t disabled. I could pick up a pencil off the floor (regardless I had to feel around for it for a good five minutes first). I can walk (regardless I can only stand for about 5 minutes before my spine gives out) but enough in their words to walk from a taxi to an office. …So because I passed these “tests” I was refused on those grounds for disability benefit. Being blind was not an issue because I could still walk so with that logic walking a few steps enabled me to see where I was going, to read letters, to cross the roads without danger just as any sighted person could. It was a miracle! I was cured!”

A powerful post on what it’s like to ‘walk in the shoes’ of a blind man – and to undergo the disability test when you’re having a very bad week.

Welfare

Universal Credit – how is this simplification?

From DPAC (Disabled People Against Cuts)

Posted on 16th September 2012

“Overpayments under the new system will not be subject to the same rights of dispute which currently exist, so many claimants simply won’t be able to properly contest an unfair decision. When government is asked about the problems all of this creates they stick to script and tell us all how ‘work pays’. The emphasis on work is backed up by an assurance that simplifying the benefits system makes it more possible to transition from welfare to work; the new highway for making the transition is Universal Credit which we are all told is ‘on track’.”

Universal Credit is meant to merge all working age benefits into a ‘single streamlined payment.’ Not according to this detailed analysis it doesn’t, originally from the MyLegal forum.

Previous reads

Here are a few more great posts from the past few weeks.

Welfare

Problem?

From This is My Blog

Posted on 12th June 2012

“The big line being pushed by our beloved government this week is about “problem families” and the need to “crack down” on them. …So what makes a “problem family”? How do we define the country’s “worst scumbags”?

Mary, a 30-year-old knitter living with her husband, a robot vacuum cleaner – and ME – finds the Government’s definition of ‘problem families’ uncomfortably close to (her childhood) home.

Policing

The high price of cutting costs

From Minimum Cover

Posted on 5th July 2012

“…there is sometimes a huge chasm between the headline saving and the bottom line cost. Some officers, including me, have resorted to sorting these types of issue at their own cost on more than one occasion. It’s just what we do to keep things running smoothly.”

M.C.’s blog – a “mixture of personal experience, factual accounts, [and] a modicum of fiction here and there to ease the literary process and protect the innocent” – reflects on how ‘cost-savings’ have turned replacing a 29 pence light bulb into a kerfuffle costing £100.

Standing outside the fire

From Cate Moore’s Blog

Posted on 12th June 2012

“I am telling you to play clever. And safe. You do not need to shy away from your ideals and the things that you care passionately about. Indeed you are letting the public down if you do. Speak truth, speak it fairly and speak it pleasantly.”

A retired policewoman encourages other officers to use social media to comment on government policy – but to do it carefully.

If you’re a frontline blogger, do send us your latest blogs on policy issues or posts from the past that you’re particularly proud of, and they could be included in next week’s round-up. Get in touch with us at: info@guerillapolicy.org or via Twitter @guerillapolicy


Andrew Lansley is gone, but his closed approach to policy-making is likely to continue

We have a new secretary of state for health  but not apparently a new policy for health, or a change in the way that health policy is made. The way to improve the NHS is apparently the same as it was before Andrew Lansley was sacked  more outsourcing and competition. Jeremy Hunt has been appointed to implement this policy by being a ‘better communicator.’ But the Government’s reforms are unpopular not because of how they have been presented, but because of how the policy was developed – including the fact that no-one voted for them.

Under Any Qualified Provider, private health providers are likely to profit because, in contrast to existing NHS services, they can offer worse terms and conditions for staff, they will not be subject to the same regulations of transparency and accountability as NHS providers or bound by the same financial regime. AQP is a not about establishing a ‘level playing field’, or even about extending proper choice (since patients will not be told who owns providers including whether they are profit-making). Rather, it’s a programme to turn the NHS into a ‘trojan brand’ for private health provision, paid for by the public, while NHS providers lose income and some will have to close – so making the NHS as a whole less sustainable.

Whether you think these are the right reforms or not, they are not a popular because the public has never voted for them and haven’t been involved in developing them. These policies are not completely new of course – many of these ideas are shared across the main political parties, and this particular policy has already been applied in elective care. But this only reinforces the point. AQP is a classic example of the ‘Whitehall consensus’ – the shared view about the obvious rightness of outsourcing held by the policy establishment in the political parties, most Westminster-centric commentators and think tanks – that ignores what the majority of people who use and provide public services including the NHS actually think and want.

Andrew Lansley’s real problem was that he epitomized this approach to policy-making. The issue wasn’t his personal style or language, more that as a member of the Whitehall consensus he assumed that outsourcing is obviously better than ‘monopoly provision.’ It’s this that explains one of his most famous quotes, to nurses at a Royal College of Nursing conference, that: “I am sorry if what I’m setting out to do hasn’t communicated itself.” He thought the case for outsourcing was so obvious that he didn’t really understand why it had to be made at all.

As befits a former senior civil servant and head of the Conservative Research Department, Lansley’s approach reflected the way that policy wonks often approach public services. They seem to assume that institutions such as the NHS can be re-engineered according to blueprints, rather than respecting them as collective institutions with complex cultural as well as organisational histories. Hiring the like-minded (and self-interested) from management consultants such as McKinsey to sketch out massive structural changes reinforces this blinkered thinking, at the expense of any real world, practical engagement with improving how the health service operates, how patients are treated, and how resources are spent and saved.

In the name of greater efficiency, Lansley’s reforms have already wasted hundreds of millions of pounds and distracted health staff from the day-to-day business of improving services. But the point of hiring McKinsey is that they ‘get it’ – they share the view that the (lack of) evidence for outsourcing doesn’t need to be put before the people because they too assume that private provision must be better than public. This outsourcing of policy to the like-minded, even though they are likely to benefit from the policies they help to develop, is the same reason that parts of public health policy under Lansley were effectively outsourced to fast food companies.

This closed and cosy approach will continue as long as the political class is largely drawn from the same old PPE-think tank-commentator axis which pays the greatest respect to an elegant argument and a nicely designed slide deck, but which lacks any real experience of public services, or indeed any broader experience of life outside the Whitehall consensus. The lack of public engagement, and public mandate, for the Government’s health reforms further erodes public confidence and trust in policy-making. The greatest irony of all is that the reforms were supposed to be about devolving power and enabling shared decision-making between GPs and patients. At the heart of these policies, however, is a fundamental lack of accountability – at the level of some (privately-provided) individual services but also for the reforms as a whole.

What’s worrying about the appointment of Jeremy Hunt is not his lack of knowledge of health services – after all, Andrew Lansley held the health brief for many years, and look what happened. It’s that in his time at the Department for Culture, Media and Sport he adopted a similar behind-the-scenes, and way-too-close, relationship with corporate interests against a loved and largely respected but inevitably imperfect public institution (in this case, the BBC). The NHS is still – just about – a public institution. Its future should be deliberated, developed and determined publicly.