Colin Beacock RCN Stewards Conference by THIl6o5


									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
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
 Local     AND Independent?

 Local     but NOT Independent?

 How      local is “LOCAL”

 Arethere degrees of Independence or and if so are they

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.
The Blairite Legacy
 Effects of Financial Recovery Plans
 Competitive tendering
 Service reconfiguration- CAPLNHS
 Provider; Commissioner split
 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
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
“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
 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

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