Local Independence RCN Stewards Conference 1st December 2007 Colin Beacock RCN Policy Unit Freedom’s just another word for nothin’ left to lose- Freedom aint worth nothin’… but Its FREE!! Adapted from “Me and Bobby McGee” Janis Joplin 1968 What the is the meaning of freedom to the modern man? He has become free from the external bonds that would prevent him from doing and thinking as he see fit. He would be free to act according to his own will if he wanted, though and felt. He conforms to anonymous authorities and adopts a self that is not his. The more he does this the more powerful he feels, the more he is forced to conform. In spite of a veneer of optimism and initiative, modern man is overcome by a profound feeling of powerlessness which makes him gaze towards approaching catastrophies as though he were paralyzed! Fromm 1982 All students, especially those who are poor, intuitively know what the schools do for them. They school them to confuse process and substance. Once these become blurred, a new logic is assumed; the more treatment there is the better are the results; or, escalation leads to success. The pupil is thereby “schooled” to confuse teaching with learning, grade advancement with education, a diploma with competence and fluency with the ability to say something new. His imagination is “schooled” to accept service in place of value. Ivan Illich (1973) Medical Treatment is mistaken for health care, social work for the improvement of community life, police protection for safety, military poise for national security, the rat race for productive work. Health, learning, dignity, independence and creative endeavour are defined as little more that the performance of institutions which claim to service these ends, and their improvement is made to depend on allocating more resources to the management of hospitals, schools and other agencies in question. Illich (1973). Local AND Independent? Local but NOT Independent? How local is “LOCAL” Arethere degrees of Independence or and if so are they acceptable? Monitoring of healthcare targets and standards- Monitor Compliance Framework 1.3.3 Authorisation requires NHSFTs to comply with material healthcare targets and standard. HCC will collect information on performance against these targets. Montor will expect NHSFTs to self-certify achievement of core national targets and standards and will follow up to seek further information from NHSFTs who are unable to self-certify in this area. Our Health, Our Care, I SAY! With increases in expenditure slowing down after 2008, following record increases over the past few years, the health service will need to focus even more strongly on delivering better care with better value for money. Finding new ways to provide services in more local settings will be one way to meet this challenge. DH Feb 2006- THE HEWITT? BLAIR MODEL The Blairite Legacy Effects of Financial Recovery Plans Competitive tendering Service reconfiguration- CAPLNHS Provider; Commissioner split rd Emerging 3 Sector providers and Social Enterprise Effects of PbR/ Choice/ Plurality Democratic deficits in the NHS Gordon Browns first speech … it is right to involve the public in a sustained debate about whether there is a case for the United Kingdom developing a full British Bill of Rights and duties, or for moving towards a written constitution. I’ll tell you what I want! John Carvell (Guardian 14/207) “some serious players in the Labour party believe the NHS may soon be unable to afford to provide a free service to everyone. They want a system of co-payment, requiring a contribution towards the cost of treatment from those who can afford to pay. For them, a constitution promising a free universal service for at least the next 10 years would be a hostage to fortune. “ … and across the UK? SNP intend to increase the accountability of health boards by introducing direct elections to health boards. In NI devolution means Constitution or Independence Board could only apply to England. In Wales, the new Assembly has pledged to create a charter which may be similar to a Constitution NHS Board… or bored with the NHS? The Darzi Model? “the review, which has the full backing of the Prime Minister, Gordon Brown, will consider the case for a constitution of the NHS as the basis of a sustainable and lasting settlement that meets these challenges, enhances local accountability, secures value for money and protects the fundamental values that the NHS has always embodied” (Department of Health, 4 July 2007 Gateway reference 8505) Wanless 3- Our Future Services Secured? The government has failed to take full account of the impact of new policies on the system as a whole and to understand how the various elements fit together with each other and the various resources. These failures were key to the system-wide deficits from 2004-05 onwards. Kings Fund September 2007 …on the effects of the reforms? Pressure to produce quick results has led to some policies and initiatives being introduced without adequate preparation… the process of organisational change has been costly, not just financially but in terms of the disruption, loss of experienced staff and changes in working relationships both within the NHS and with external organisations. …will they listen? The emphasis should be on developing the new policy framework rather than subjecting it to further fundamental reform. Although changes in policy and practice must continue, structural change should be avoided wherever possible. …and what the government should do about it! Encourage use of systems reforms to achieve desired outcomes Produce regular long term resource estimates Measure and manage productivity ….AND!!!! Monitor and Assess Policy and Performance The government needs to strengthen its analytic capacities to monitor the effectiveness of it’s policies, and be prepared to change direction or pace of policies are unlikely to have the desired impact. …and that’s all from me! …and thats all from him!!! Until the next time, thank you and goodnight!!!
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