Manchester Mayhem

A crazy day after Manchester City Council confirmed that it was to make 2,000 staff redundant. A few minutes after I’d heard about on the Today programme just after 7am, they rang up to ask me to comment! Apart from a Today interview, which you can listen to here, I’ve done interviews for BBC Radio Manchester, BBC TV North West Tonight, Manchester Evening News, BBC TV News channel and a blog post for The Daily Telegraph which you can read here. Continue reading

Quangos (again)

Last week the Public Administration Select Committee published a hard-hitting, extremely blunt, report criticising the way in which the Government’s (non) bonfire of the quangos has been conducted. Well worth a read – one of the most intriguing suggestions was that many quangos should be turned into executive agencies, which for those of us who have studied these things is a very interesting suggestion. (see my two books on the quangos and agencies here and on agencies here.

My own written contribution appears in the report here, and there’s oral evidence and several references to my two-pence worth in the body of the report..

Who Will Own GP Consortia?

I have been trying – and I confess failing – to try and get my head around a simple question: who owns (or rather will own) GP consortia? The legal status of these bodies may seem a bit pedantic, but it could have a fundamental affect on the dynamics of the New Model NHS. This is an issue that I haven’t seen properly discussed in any of the comment and analysis so far.

Most people forget, if they ever knew, that GPs are not NHS employees but independent contractors. Although some work in NHS premises, many (most?) own their own buildings and single or group GP practices are small businesses. Many GPs have already done very nicely by using NHS funding – quite legally – to improve buildings and businesses that they own.

Primary Care Trusts (PCTs) are, on the other hand, publicly owned and controlled bodies. GP Consortia (let’s call them GPCs for short) seem to have a rather more ambiguous status. Are they public, or are they private, or some sort of hybrid?

The reason it matters of course is that if these GPCs are going to be managing 80% of the NHS budget, or £80bn in today’s budgets, what incentives will they have? If, for example, they are essentially private small businesses then the is every incentive for them to bias decisions in their favor. Because, when they are “commissioning” care they could, if the system allows this, commission themselves instead of NHS Trusts to provide services. This could be either as a GPC or, presumably, as GP practices? Either way, they could stand to make money, either directly or indirectly, from such decisions.

GPCs will also have, of course, a budget for running themselves. In some cases, they will presumably be collocated with GP practices. Again, how exactly will the private interests of the GPs who own these medical businesses be kept separate from the (presumably) public GPCs?

Now I am sure most GPs are good and honest folk with only the best interests of their patients and the taxpayers at heart. But some might not be, and the temptation could be very great indeed to cream off a little of that £80bn, could it not? Especially as it could almost certainly be justified as providing better local care for patients.

So I remain puzzled and dig as I might have so far been unable to establish just what the status of these GPCs will be. Maybe they will just be public bodies. Anybody else know?

Wrong sort of snow on the line to recovery?

Toady’s economic results were worse than anybody expected. The world economy is growing faster, and we are back into recession territory. And the Chancellor’s explanation – the wrong sort of snow.

Growth in the last three quarters has dropped from +1.1%, to +0.7% and now down to minus 0.5%. it doesn’t take a rocket scientist to understand that trend, nor it’s primary cause. The government has been taking money out of the economy, through it’s ’emergency’ Budget and Spending Review and tax increases like there is no tomorrow. But, no, it was the snow what done it.

The danger now is obviously a real, or rather further, collapse in consumer and business confidence leading to a real and serious double-dip recession when the rest of the world is starting to power ahead.

According to the Coalitions economic policy, if this does happen the answer will be not to take their foot off the break but to stamped down even harder. If cutting public spending ‘secures the recovery’, as they have foolishly claimed already, then clearly if it doesn’t it will be because they didn’t cut hard enough, according to Osbornomics. I very much doubt they will pursue such a course, but with this lot, who knows?