British Journal of Healthcare Management, Mar 1, 2002
This article considers the inherent problems in attempts to realise The NHS Plan, and suggests so... more This article considers the inherent problems in attempts to realise The NHS Plan, and suggests some solutions to the paradoxes to be confronted.
This month's Provocations feature looks at the content of Secretary of State Alan Milburn'... more This month's Provocations feature looks at the content of Secretary of State Alan Milburn's speech launching the Modernisation Agency. What does it all mean?
Introduction Integrated health and social care systems are central to enabling person-centred car... more Introduction Integrated health and social care systems are central to enabling person-centred care for people with complex needs. This paper reviews the evidence for systems leadership as a vital component in the delivery of these integrated systems. Delivering integrated health and social care for end of life care is seen as a remedy for the failings demonstrated in the Health Service Ombudsman’s report. Putting the development of integrated systems for end of life at the heart of the NHS agenda is recommended in both the 2015 Health Select Committee report on Palliative Care and the 2015 Choice Review. Hospices bring unique strengths to system leadership, not least their ability to use independence, resources, and expertise to bring the system together in the pursuit of improvement. Hospice leaders can offer system leadership and are well placed to work across organisational boundaries and contribute to the development of integrated care. Aims This paper will showhow the hospice sector can use system leadership to create the necessary conditions for change and how hospice leaders can use their connexions and skills to deliver it. Methods The literature review identifies themes in the discussion of systems leadership in relation to end of life care and the role of the hospice and of hospice leaders. These themes include the legitimacy of the hospice as a system leader and the potential role of hospice leaders in shaping new integrated systems of care. The paper will present a discussion of the way in which hospices and individuals might grasp this opportunity. The discussion will be based on deliberative focus groups with a purposive sample of hospice leaders. Conclusion This paper highlights the opportunity that system leadership creates for both hospices and their leaders to shape the development of integrated health and social care at the end of life.
At present, NHS managers are highly constrained, suffering excessive regulation and central contr... more At present, NHS managers are highly constrained, suffering excessive regulation and central control. More autonomy for trusts would mean fewer directives and less performance management. Giving trusts a new organisational form, such as a public interest company or foundation hospital, might be reinvigorating and would not involve further reorganisation. These new freedoms should be accompanied by new accountabilities, not solely to politicians but to independent NHS regulators, local communities and patients. Devolved power and greater patient choice could produce a more responsive NHS. Its potential needs to be explored through experimentation and evaluation.
This paper describes the new approach being taken to quality improvement and assurance in the UK ... more This paper describes the new approach being taken to quality improvement and assurance in the UK through clinical governance. The purpose is to identify what is required to make clinical governance work. The paper outlines an underlying set of themes within clinical governance and establishes the central role of interprofessional collaboration in achieving policy aims. It discusses the role that new accountabilities may play in supporting the development of clinical governance in secondary care and the need to consider networks of accountability as an effective way of underpinning collaborative effort. It is argued that a strong backbone of accountabilities will help generate the culture of collaborative working that is necessary to achieve clinical governance objectives. The paper highlights three areas where there are weak links in the chain of accountability.
This article reviews the King’s Fund’s efforts to establish shared priorities for learning with g... more This article reviews the King’s Fund’s efforts to establish shared priorities for learning with grant applicants, to improve Londoners’ health through community-level projects. The Fund used partnership working for its Partners for Health grant programme, an innovative framework contrasting with the typical, more narrow and limited, model for funding relationships. The related focus on learning required robust evaluation plans from grant applicants, based on the ‘realistic evaluation’ approach. This shift to grant-aid relationships based on partnership and learning produced varied reactions, and raises far-reaching issues about the challenges presented by partnership that feed into broader debates about the place of partnership in public services.
British Journal of Healthcare Management, Mar 1, 2002
This article considers the inherent problems in attempts to realise The NHS Plan, and suggests so... more This article considers the inherent problems in attempts to realise The NHS Plan, and suggests some solutions to the paradoxes to be confronted.
This month's Provocations feature looks at the content of Secretary of State Alan Milburn'... more This month's Provocations feature looks at the content of Secretary of State Alan Milburn's speech launching the Modernisation Agency. What does it all mean?
Introduction Integrated health and social care systems are central to enabling person-centred car... more Introduction Integrated health and social care systems are central to enabling person-centred care for people with complex needs. This paper reviews the evidence for systems leadership as a vital component in the delivery of these integrated systems. Delivering integrated health and social care for end of life care is seen as a remedy for the failings demonstrated in the Health Service Ombudsman’s report. Putting the development of integrated systems for end of life at the heart of the NHS agenda is recommended in both the 2015 Health Select Committee report on Palliative Care and the 2015 Choice Review. Hospices bring unique strengths to system leadership, not least their ability to use independence, resources, and expertise to bring the system together in the pursuit of improvement. Hospice leaders can offer system leadership and are well placed to work across organisational boundaries and contribute to the development of integrated care. Aims This paper will showhow the hospice sector can use system leadership to create the necessary conditions for change and how hospice leaders can use their connexions and skills to deliver it. Methods The literature review identifies themes in the discussion of systems leadership in relation to end of life care and the role of the hospice and of hospice leaders. These themes include the legitimacy of the hospice as a system leader and the potential role of hospice leaders in shaping new integrated systems of care. The paper will present a discussion of the way in which hospices and individuals might grasp this opportunity. The discussion will be based on deliberative focus groups with a purposive sample of hospice leaders. Conclusion This paper highlights the opportunity that system leadership creates for both hospices and their leaders to shape the development of integrated health and social care at the end of life.
At present, NHS managers are highly constrained, suffering excessive regulation and central contr... more At present, NHS managers are highly constrained, suffering excessive regulation and central control. More autonomy for trusts would mean fewer directives and less performance management. Giving trusts a new organisational form, such as a public interest company or foundation hospital, might be reinvigorating and would not involve further reorganisation. These new freedoms should be accompanied by new accountabilities, not solely to politicians but to independent NHS regulators, local communities and patients. Devolved power and greater patient choice could produce a more responsive NHS. Its potential needs to be explored through experimentation and evaluation.
This paper describes the new approach being taken to quality improvement and assurance in the UK ... more This paper describes the new approach being taken to quality improvement and assurance in the UK through clinical governance. The purpose is to identify what is required to make clinical governance work. The paper outlines an underlying set of themes within clinical governance and establishes the central role of interprofessional collaboration in achieving policy aims. It discusses the role that new accountabilities may play in supporting the development of clinical governance in secondary care and the need to consider networks of accountability as an effective way of underpinning collaborative effort. It is argued that a strong backbone of accountabilities will help generate the culture of collaborative working that is necessary to achieve clinical governance objectives. The paper highlights three areas where there are weak links in the chain of accountability.
This article reviews the King’s Fund’s efforts to establish shared priorities for learning with g... more This article reviews the King’s Fund’s efforts to establish shared priorities for learning with grant applicants, to improve Londoners’ health through community-level projects. The Fund used partnership working for its Partners for Health grant programme, an innovative framework contrasting with the typical, more narrow and limited, model for funding relationships. The related focus on learning required robust evaluation plans from grant applicants, based on the ‘realistic evaluation’ approach. This shift to grant-aid relationships based on partnership and learning produced varied reactions, and raises far-reaching issues about the challenges presented by partnership that feed into broader debates about the place of partnership in public services.
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