National standards in health and care ‘not our role’ says Coalition

Labour must define itself by defending a core level of service quality - putting back the National back into the NHS, and a new National Care Service as well.

Refusing to set or support minimum standards for health and social care is now confirmed as integral to the Coalition’s ‘big society’ vision. Despite ministers’ rhetoric on promoting service outcomes, and against the biggest post war cuts in public services, the Coalition is walking away from any role in or accountability for maintaining core standards.

In the summer, the Coalition scrapped the national Comprehensive Area Assessment (CAA) system to enhance improvement across local government and other public services. Communities secretary Eric Pickles took delight, on abolishing the CAA, in describing the “Whitehall reaction” as civil servants asked him:

Q: “But what things do we want local authorities to be judged on? What’s the regime?”

Pickles: “Nothing.”

Q: “So just to be clear Secretary of State, when you say nothing, what do you mean?”

Pickles: “Nothing. I mean nothing, absolutely nothing. It’s pointless. It doesn’t do anything.”

The Coalition is now consulting on its plans to develop a set of outcomes for the NHS, followed next month by social care, and then public health. At first glance, these outcome frameworks sound promising, appearing to build on Labour’s progress in using targets and incentives towards quality improvements in stroke, cancer and high volume surgery like hip fractures.

These are significant numerically as well as life threatening: there are 120,000 strokes and 70,000 hip fractures annually.

The Coalition‘s consultation document only refers to measuring progress against outcomes to “provide the public with meaningful information about which to base their choices about their healthcare”, making the NHS more accountable to patients and freeing it from “top-down control”. Health secretary Andrew Lansley says:

“Putting the information out there is a catalyst. It drives comparison and performance.”

Yet publishing outcomes data is meaningless without quantifying expected improvements and a clear reward system, as doctors who have run national clinical audits will testify.

David Cameron presents himself as on the professionals’ side, against:

“… big government, with their endless targets and reorganisations… We’ll say to the doctors: those targets you hate, they’re gone.”

Yet doctors are getting concerned about where standards will feature. The BMA’s recent response to the NHS White Paper states:

“… we would not support the wholesale replacement of process targets and indicators with clinical and patient reported outcomes measures. There is clear evidence that the use of process measures is an effective management tool for judging and rewarding quality.”

Meanwhile the big society vision is for a smaller state and a local open market to run what is left. Coalition big society lead minister, Greg Clark, explains:

“The more we get away from the idea of a single source of help, delivered by a unitary state, ruling over a monolithic public sector, the closer we will get to a big society.”

The Coalition’s blue-print then, is clear: national standards and universal entitlement to good quality local services are now optional, down to local discretion. They become the exclusive responsibility of local agencies and a patchwork of providers, subject only to local accountability. Nowhere does the Government feature.

A key question is whether localism and the big society vision are sustainable politically, both to voters and to the Liberal Democrat part of the Coalition. Can you combine financial slash and burn whilst delegating accountability – during the whole of a spending review cycle?

For Labour the opportunity is clear: to define itself by defending a core level of service quality. This means putting back the National back into the NHS, and maybe into a new National Care Service as well. It also means building a vision that combines equality of outcome and responsive services, whilst exposing how the Coalition’s big society will weaken communities.

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53 Responses to “National standards in health and care ‘not our role’ says Coalition”

  1. John Hickey-Fry

    RT @leftfootfwd: National standards in health and care 'not our role' says Coalition: http://bit.ly/a5n7lE

  2. John West

    RT @leftfootfwd: National standards in health and care 'not our role' says Coalition: http://bit.ly/a5n7lE

  3. Josh Blacker

    RT @leftfootfwd: National standards in health and care 'not our role' says Coalition: http://bit.ly/a5n7lE

  4. Andrew Holland

    National standards in health and care 'not our role' says Coalition | Left Foot Forward: http://bit.ly/9L2JJI

  5. Rosie

    RT @andyholland01: National standards in health and care 'not our role' says Coalition | Left Foot Forward: http://bit.ly/9L2JJI

  6. Alec Speight

    Another day another reason to despise the Tories and their LibDem poodles ( http://bit.ly/9abypT )

  7. Brooke Casey

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  9. Uncle Herba

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  10. Martin Johnston

    easy being in Government isn't it? RT @leftfootfwd: National standards in health and care 'not our role' say Coalition: http://bit.ly/a5n7lE

  11. their_vodka

    National standards in health and care ‘not our role’ says Coalition http://bit.ly/bOPIef #nhs

  12. Paul Dean

    Surely any good manager will set up local standards and performance measures that are maximally useful to him locally. He can use, or borrow from, national standards and measures insofar as it will help him and where they don’t help him he can drop them. Great! To say otherwise is to assume that the managers are bad. It’s terrible business to micromanage managers under you; instead give them the freedom to do the good job you train them to be able to do.

  13. jeff marks

    Couldn’t agree more, Paul. The idea that not setting central targets or standards means you don’t want high standards is just lefty distortion and newspeak.

    “For Labour the opportunity is clear: to define itself by defending a core level of service quality. This means putting back the National back into the NHS, and maybe into a new National Care Service as well.”

    Labour – Putting the National back into Socialism

  14. Lizkearton

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  16. Health Care

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  17. Craig Nelson

    Actually the Tories are playing a bit of a game with many of the targets. Supposedly they have abolished the 4 hour wait in A+E. At the local level it’s still in force with no plans for it to be got rid of that I can see.

  18. Evidence based.

    What about organisations such as Healthwatch, who with consulatation with patients will help bring pressure on failing trusts? What about the fact that there will be online rating of trusts which will allow consumer choice to dictate as to where paitents want to go to be treated- thus increasing the incentive of hospitals to have the best standards possible.

    I’m sorry you’ve ignored wide swaths of proposals that don’t back up the point you want to make.

  19. jeff marks

    @Craig

    the whole point is to abolish national targets. if local people want local targets then that is up to them. it’s not a game, it’s called localism.

    talk about getting the wrong end of the stick

  20. Anon E Mouse

    Trevor Cheeseman – You really don’t get it do you?

    The big state Labour model has left us with a debt we cannot repay and services that mean the police spend more time on paperwork targets than fighting crime.

    The electorate may not have voted Tory outright in May but it certainly threw Labour out with their second worst election result ever and the loss of 5 million voters in 10 years.

    You are fighting the last election – there’s a new politics in town and you seem to have missed it…

  21. Sally Rogers

    What NHS staff and patients dislike most of all is a post-code lottery, which is the likely result of these reforms (just look at NW Essex service cuts announced this week).

    Most NHS managers I work with, and growing numbers of clinical staff, prefer a clear target otherwise typically the Finance people overrule them saying there is not the money to fund service developments. Healthwatch may be useful but in practice its predecessors (CHC, PPI, PALS) had limited influence . I agree there is a risk of micromanagement but minimum standards will be necessary at a time of cuts, unless a postcode lottery is what you are happy to accept….

  22. Trevor Cheeseman

    Anon E Mouse – when Labour left office crime was at its lowest rate since 1981. Labour led investment in public services, then avoided a depression via propping up the banks financially, which the Tories did not oppose. They now proposes a slower rate of deficit reduction to avoid economic stagnation.

    There is a growing impression the Coalition’s NHS agenda is an Achilles heel. Just look at the reaction of health professionals…..but you seem to have missed it.

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  35. Anon E Mouse

    Trevor Cheeseman – Crime? How about violent crime Trevor? Up 44% under the hopeless Labour government – all you’re doing is selectively choosing statistics to “prove” this flawed article, which it doesn’t.

    Investment in public services? Yeah right. PFI anyone?

    Why wasn’t there a corresponding increase in productivity to the levels of investment? MRSA – what happened to the terminally useless Gordon Brown’s “Deep Clean” – remember that one? The reaction of health professionals? Which ones?

    The fact is Labour have left our country wrecked by debt which is partially structural, CCTV cameras monitor our every move, police stations are closed at night, over 80 000 people languish in jail, the police act like thugs at protests and they wanted ID cards.

    Thank goodness Nick Clegg’s going to get a grip and start ripping out stupid unwanted Labour laws such as HIP’s. What did that cost the taxpayer I wonder?

    And you are still advocating positions that cost Labour the last election – Ed Miliband seems to get it, why don’t you?

    It’s over Trevor – socialism is dead. Yee ha.

  36. Localism or a postcode lottery? | Left Foot Forward

    […] between the perhaps laudable ideal of ‘localism’- and the bothersome and difficult task of maintaining national standards – and the ‘bonfire of quangos’, which may lead to centralisation or deregulation depending on […]

  37. Chris

    Oh dear, Cashcroft’s sockpuppets are out in force. We’ve got jeff marks, plumber and social darwinist. Mental mousey, always letting us know the current political consensus on his secure wing. Oh and Evidence Based? who is just boring.

  38. Chris

    @Mental mousey

    “Up 44% under the hopeless Labour government – all you’re doing is selectively choosing statistics to “prove” this flawed article, which it doesn’t.”

    http://blogs.channel4.com/factcheck/did-cameron-get-his-violent-crime-statistics-right/3056

    “Investment in public services? Yeah right. PFI anyone?”

    100 new hospitals, 4000 secondary schools, etc – your a lying mental mouse.

    “Why wasn’t there a corresponding increase in productivity to the levels of investment?”

    Yawn, why would you expect to see productively increase when the whole problem with the NHS pre-97 was the disgracefully low ratio of staff to patients. The same with teachers, cutting primary school class sizes to under 30 isn’t going to do anything for productivity but will greatly improve a child’s education!

    Your a lying fucking tory sockpuppet!!!

    “The fact is Labour have left our country wrecked by debt which is partially structural”

    You don’t have a fucking clue what your talking about, debt partially structual ffs. Our debt ratio is lower than France, Germany, USA even now! Our deficit is larger, this is the “thingy” that is “partially structural”, than France, Germany, USA but that reflects our over reliance on the banking industry. While this deficit needs to be reduced by tax rises and spending cuts, it should be done over time with a growth strategy the more the economy grows the less the cyclical part of the deficit is.

    With all the money Cashcroft has to pay, I’d have thought he could have recruited a sockpuppet who actually understands something of economics rather than mentalist – did you get your job through remploy?

  39. jeff marks

    time for your medication Chris. no need for swearing.

    shouldn’t you be pissed up on white lightning by now anyway? it’s getting late for the core labour vote

  40. Chris

    @jeff marks

    Yawn, had a good day cleaning drains?

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  45. jeff marks

    pissed your benefits up the wall yet?

  46. mike

    so when your waiting in Accident Emergency

    you dont care if you wait on a trolley for a day or two

    thats what happened when we didnt have targets

    but then the Tory view is only the poor use the NHS

  47. Anon E Mouse

    Chris – No one else on this blog swears in an open forum. Can I please request that you stop two things:

    1. The aggressive tone and constant swearing should be saved for Labourlist and that type of place. (The moderators on this blog are quick enough to censure Billy Blofeld and just because they share your minority views their actions should be equal)

    2. Your remarks about mental patients might have been humorous the first time you made them but there are people here with physical disabilities that may take offence – your Remploy remark is pretty low – please stop and grow up.

    I can understand that remarks you make like: “Your a lying fucking tory sockpuppet!!!” may sound good to your classmates but are just childish in the extreme and for the last time kiddo the word is “you’re” and not “your”.

    Please take your “Cashcroft” and other immature remarks and save them for the 6th form debating society – your comments serve to remind everyone just how out of touch Labour supporters are. Did you really not see Ed Miliband at the conference?

  48. Keith Wilson

    RT @leftfootfwd: National standards in health and care 'not our role' says Coalition http://bit.ly/9xNSaT

  49. Chris

    @Mousey

    Yawn, the pathetic sockpuppet is now on his high horse. Your arguments are never consistent nor logical, you’re ready to take any position to rant about Labour no matter how much evidence is provided proving the opposite. In short your either a mental tribalist or a paid sockpuppet. I won’t take lessons from the likes of you, I’ve read your pathetic attempts to smear Joss Garman as a Labour stooge when he is the total opposite. Your slavish promotion of the coalition party line complete with reliance on statistics proven to be wrong or misinterpreted.

    “1. The aggressive tone and constant swearing should be saved for Labourlist and that type of place. (The moderators on this blog are quick enough to censure Billy Blofeld and just because they share your minority views their actions should be equal)”

    LOL, interesting – the tone of debate on Labourlist is anything but aggressive with a much stricter moderation policy. In a previous thread where “Billy Blofield” alleged that his comments had been moderated he later retracted it, why are you repeating the lie that right wing comments on this site are deleted?

    “2. Your remarks about mental patients might have been humorous the first time you made them but there are people here with physical disabilities that may take offence – your Remploy remark is pretty low – please stop and grow up.”

    I bet if I could be bothered to look I could find you complaining bitterly about Labour “political correctness gone mad”.

    “Please take your “Cashcroft” and other immature remarks and save them for the 6th form debating society – your comments serve to remind everyone just how out of touch Labour supporters are. Did you really not see Ed Miliband at the conference?”

    You claim to be the voice of the disillusioned Labour voter but having canvassed hundreds over the past 6 months I’ve never heard any of opinions you spout. I prefer to gain insight by talking to real people rather than morons on comment threads who claim said insight because their parents or some bloke in a bar agrees with them.

    If you don’t want me to savage your party politically motivated attack comments don’t spread lies and fud about Labour’s record.

  50. Wendy Maddox

    RT @leftfootfwd: National standards in health and care 'not our role' says Coalition http://bit.ly/9xNSaT

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