The CQC and the NHS

Poor Standards, cover-ups and scandal seem to be swirling around that most beloved institution, the NHS.

One of the most fascinating thing I have been involved in over the past few years is learning about this thing called the NHS, for it is not one thing but a vast collection of organisations often competing with itself and local government, it is extremely complex and ‘eats’, after welfare, more of our nation’s money than anything else and more than the entire cost of Defence, Local government, Home office costs and overseas aid put together.

The latest scandal is of course the Care Quality Commission (CQC) cover-up and its interesting watching David Behan, it’s new Chief Executive, a former local Government Director of Adult Social Services and latterly chief civil servant to successive Care Ministers deal with the political and public fall out. Somewhat less visible has been the organisation’s new chairman David Prior, which is a surprise given his political background, it’s interesting and such a small world that he lost his North Norfolk seat to one Norman Lamb in 2001 by just 483 votes, who of course is now the Care Minister.

I recall a few years back the reformed CHC coming to a meeting in Endeavour House, Ipswich and telling us of the scope and scale of the organisation going forward and how the new regime was about simple registration of Care Homes and Health organisations and how this process would ensure standards. I and officers left that meeting ‘gob-smacked’ at what was being proposed and perhaps what we are seeing today is a direct result of those decision taken then, in essence I think we have seen an organisation trying to step up but with extremely limited resources. I have met with David Behan on a number of occasions, particularly around the challenge of the Dilnot reforms and if anyone can move that organisation forward it is him, provided he is given the resources with which to do so.

Indeed if, and I have, you have ever read one of their reports it is clear that the process is far from robust and often anecdotal at best. There are some commentators who are saying that one regulator going forward who covers social care, primary care, dentistry and hospitals is ridiculous. I don’t agree with that but do say that what is ridiculous is the level of funding provided to carry out their function. To say they are thin on the ground would be something of an understatement, in Suffolk they have two part timers covering the whole system, a system that employs tens of thousands of people and spends a collective £1.5Billion. How do two part timers hope to meaningfully report.

So what we have is a swirling bubbling pot, add to the truly shocking Francis report about hospitals and the clear blueprint he proposes for change both in our hospitals, their accountability to patients and indeed the role of Local Government Scrutiny; next add in the new Healthwatch organisations and Health and Wellbeing boards and it is difficult to see what we will get, how do we create a robust system of monitoring and checking not only to make sure our hospital and health system is safe but actually drive forward improvements.

Sometime ago at the creation of Police Commissioners I blogged about the notion of Health Commissioners, the care and health system is vastly more complex than the police service, vastly more important to most people’s daily lives, collectively it spends, in Suffolk alone, about 1000% more than the police service and yet is for the main part at the local system level is essentially democratically unaccountable. I think to improve and move forward an important element must be meaningful local democratic accountability. I continue to pounder that a Health Commissioner would have the democratic mandate and accountability to pull all of this vast complex system together at a local level for the better. Mind you what a job!

The Networked Councillor – more than Twitter

Monday morning, gathered at the Moller Centre in Cambridge were a small but wide ranging roundtable of policy wonks, local government officers, old hands such as Cllr. Richard Stay from Central Beds Council and myself and a cross section of new and prospective Councillors,  to test out some of the conclusions in a East of England LGA’s Improvement East commissioned paper called the Networked Councillor, which I took part in the research for, lead by Catherine Howe of Public-I Consulting.

Slightly aside but sometimes it can be an extremely small world, as I prepared for the event I thought about a new web site called and the very first UK political ‘Thunderclap’ being a by-election for Brighton Council put up by the Greens; and the next day sitting opposite me at the roundtable is the Labour candidate for that very ward.

The paper and discussion is about trying to move the debate about social media on, as important as the tools are and you need to learn how to use them, social media is not about ‘oh you need to get onto Twitter’. Equally it’s not about technology either Blackberry 10 V iPhone; Window’s 8 V iPad; Twitter, Pinterest, Facebook, or Flickr – but it is about Democracy and Engagement. Nor is it the silver bullet, the new way to politically campaign and represent your community.

I for one believe that what it’s actually about is being accessible, going to places where people gather and working with your community to get the best out of the system whatever that may be. People gather on-line but they also gather in village halls and Parish Council meetings. Thus social media and its use is part of the tool set a Councillor needs but no more important than shoe leather and shaking hands.

Of course the other great reason to make social media a part of how you go about being a Councillor, a part of your tool kit,  is that just because you don’t use social media does not mean people are not talking about you, because they are and unless you are a part of that, you cannot hope to address their issues or influence their thinking; so to my mind it compliments rather than replaces other political activity.

One the most interesting strands of the event was the discussion around engagements and how this is changing. reflecting on the day and to some extent testing out some of the points discussed,  in a meeting the afternoon of the Suffolk County Council (SCC) Conservative Group and then again in the SCC Leadership meeting the following day I pondered why is there an ever decreasing numbers of people who engage in elections? Could it be that we as voters and residents are changing, partially because of social media and becoming not so much disillusioned with politics but increasingly dissatisfied with the nature of representation offered.

One of the team writing the report made an interesting set of comments about where we are today with the internet owing more to the egalitarian and collaborative working principles of Californian student life of the 60’s and 70’s than to corporate business. The notion of how to make money out of some of the biggest companies in the world today did not come from how to get rich quick nor the profit bottom line of the transaction but how to connect people such as with Facebook, of course that has made its founders extremely rich but perhaps not where it started out.

The internet and cloud computing is buzzing with sites such as Thunderclap and is the nature of how we expect to be engaged with and socialise on-line in a collaborative way; and is this ability and expectation starting to frustrate people with their interactions with local government and indeed democracy?

So can social media change be the tool to move from being communicative, which I think we are reasonable at, to collaborative which we work hard to be and then perhaps co-productive with our residents, I think we can but it must also be a cultural shift within Local Government in using the tools of social media.

The final version of the Networked Councillor report will be launched at the LGA Conference in Manchester at the beginning of July and for anyone interested in Local Government and Social Media I think it will make for essential reading as a snap shot of this moment in time and a contribution about how Councillors can use Social media as a part of how they go about their changing roles.

I’ll put up a link as soon as it’s published.

Suffolk Flexicare Conference

Making my point at the Conference

Making my point at the Conference

Last Wednesday week we held the return conference, Suffolk Flexicare 2, almost 2 years to the day after Flexicare 1, in the same location of Newmarket racecourse. In some ways it was slightly surreal seeing my successor as Cabinet Member for Health and Adult Care chairing the meeting after living and breathing adult social care in Suffolk for 4 years, but Cllr. Dr. Alan Murray did so with great aplomb, as I know he will do the role, we even share a joke about being a double act hopefully more Morecombe and Wise that Dr. Jeckle and Mr. Hind not sure which I am but in my closing remarks I said I have short fat hairy legs and he wears glasses, sorry sort of an in-joke on the day.

Alan and I are working together as he learns the ropes on what is a vast and difficult service area and of course he brings to it an added dimension with his considerable experience in Health.  I hope as we debate the coming years budgets my experience in this service area will be useful as collectively we grapple with the demands of an ageing population and less money to provide services indeed provide services across all areas of the Council’s service delivery for the people of Suffolk, a challenge I now have political responsibility for. In many ways the issue of finance and our ageing population go hand in hand, I think we all have a vision of what we want, now we have to work out how we afford it.

The day was a mixture of key note speakers from the excellent Stephen Burke of United for all Ages a really intelligent think tank on the subject of housing in our society to Stephen Javes, CE of Orwell Housing who delivered his usual challenging thoughts on the way forward for social housing and in particular Extra Care Housing which is Suffolk is called Very Shelter Housing a kindly reference to Judith Hawshawk the powerhouse who pioneered such a thing in Suffolk before she so untimely past away. Their speeches were interspersed by a number of speakers who offered a different perspective of being form local voluntary organisations and older people who talked about their aspiration for their future housing needs.

Amongst the break out sessions was one I am particularly proud of, hosted by SCC’s former officer Dan Gaul now of Change3C who was presenting the Housing LIN tool for understanding the ageing population numbers drilled down to town and villages. I am proud as this is something he and I worked on together when I felt it was absolutely vital in planning terms for local planning authority officers and Councillors to be able to translate national ageing data set at and into their community level and I am proud to see this now available to all Councils through the Housing LIN.

I closed the day and focused on two things really firstly the notion that actually getting housing right for older people can be about aspiration and needs rather than settling for something that addresses their needs and the challenge to move and create an environment where Developers, social entrepreneurs and Registered Social Housing providers can come forward, invest and delivery the vast number of schemes we will need to see to address the needs of this one part of our ageing population needs.

The corporate peer challenge and role of peers

Last Friday I went along to Local Government House for a training session on the corporate peer challenge and a discussion about the role of peers; as I am now an accredited peer and keen to see if I can add value to this process.

As I sat in the room I cast my mind back to my first visit to LGA house in 2006 and the journey I have personally been on since them, sitting in the room Friday was a cohort of leaders and former this and that’s many of whom I have got to know of the past few years. Each with many years of experience and knowledge that can help others as they grapple with this thing called Local Government.

The peer challenge is essentially about going to help other Councils and Councillors across the political divide. Having spent 4 years in the role of Cabinet Member for Adult Social Care in Suffolk I hope I can offer a sense of setting a strategic direction and them how to drive that through. I also have a regional and national prospective having been involved in a number of lobbying campaigns with both this Government and the previous Labour one.

To me the training Friday seemed very sensible and something of an extension of the work I have tried to do in building the LGA Lead Member for Heath and Adult Social Care network in East Anglia as a space for members to come along, here the latest thinking and share some of our more difficult issues and hear form others as to how best to overcome these.

In my experience, there seems little you will come across that someone else has not and rather than reinventing wheels and making the same mistakes; the true strength of networks and the Corporate peer changeling is to use others experience to advance the organisation and service delivery in whatever aspect of local government that might be without repeating others mistakes.

Now more than ever we need to be think, plan and simply be more intelligent about how we move forward, as we face the challenge of rising demand and public expectation, at a time of less money with which to do things.

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