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Health Sciences and Practice Subject CentreInterprofessional Education Special Interest GroupDevolution and Interprofessional Education: how are the UK regional identities enacted in policy visions for health, and what is the impact on interprofessional education?18/04/2011
Health & social care policies in England and their impact on IPELynda d’AvraySt George’s, University of London
www.health.heacademy.ac.uk
Health & social care policies in England and their impact on IPELynda d’AvraySt George’s, University of London
Policy implications
• Implications for collaborative practice are hard to deduce and for IPE even harder
• Generalising between countries maybe hazardous
• Differences maybe as great (or greater) within countries as between
Differences between the countries:• In organisation, coordination and
delivery of services – public, private and charitable – which help or hinder collaborative practice
• Some of these are national, others north v south, urban v rural etc. Northern English cities are far more like Scottish cities than southern England
Labour government reforms 1997-2010• 1997 The New NHS, NHS Primary
Care Act (PCGs) • 1999 Walk-in NHS centres, NICE• 2000 NHS Plan, PCTs, NSFs• 2001 NHS Modernisation Agency• 2004 Foundation Trusts• 2005 Treatment centres• 2006 Our health, our care, our say(Predated by the 1970s community
mental health teams)
Drivers for IPE in England
High profile cases:• Baby Peter (Reports 2009-10)• Victoria Climbie (Laming report 2003)• Shipman (Report 2005) • Bristol Royal Infirmary (Report 2001)• Beverley Allitt (Clothier report 1994)
IPE development across England
• Funded and non-funded initiatives• Pre and post-registration• Shared/common learning• Integrated/interactive learning• Classroom/practice based• Planned and serendipitous
2010 Coalition government
• Economic, social and educational impact
Economic impact
The relative impact of the recession and cuts in public funding on:
• poverty, unemployment etc. • the wellbeing of individuals, families
and communities
Scotland (with more generous exchequer funding) is spared some of the pain for students and older people
Impact on education
• HEI and student funding slashed
• Student fees up to £9,000
• Poorer students excluded
• Shortfall – leading to increase in overseas students?
• Teacher training to be shifted away from HEIs to schools
Social impact
• Cuts in public services
• With implications for professional practice
• E.g. cuts to staff training in children’s homes
Children’s Home cuts• 12,000 children are in residential care homes• Annual staff training cut to just 69p a head• Out of £113m training budget, only £25,000 is
for the children and young people's workforce • Most is for training social workers in the
community, the priority since Baby Peter• Children's home workers must undergo formal
induction and work towards or hold a workforce diploma qualification
• Many are paid only the minimum wage and turnover is high
Meanwhile Scotland is funding a nine-year investment programme to support the workforce in its children's homes
Health & social care bill (January 2011)
The Bill contains provisions covering five themes:1. strengthening commissioning of NHS services2. increasing democratic accountability and
public voice3. liberating provision of NHS services4. strengthening public health services5. reforming health and care arm’s-length bodies
Key proposals for reorganising the NHS in England
The bill's key proposals include:
1 Give new consortiums of GPs across England the task of commissioning the healthcare they deem appropriate for their patients, and control over the budget – £80bn – to pay for that.
Accountability and public health
2 Make the NHS more accountable to patients and the public by establishing Healthwatch, a new independent body that can look into complaints and scrutinise the performance of local health providers
3 Improve public health by establishing a new body, called Public Health England, to improve public health and reduce health inequalities between the richest and poorest
Foundation hospitals
4 Compel all hospitals in England to become foundation trust hospitals – that is, semi-independent of Whitehall control with, for example, the freedom to earn money by treating certain numbers of private patients
Around half already have that status. Growing numbers have acquired FT status since Tony Blair was accused of breaking up the NHS by introducing the concept
CutsBy 2013:5 Abolish the 150 or so PCTs6 Abolish the 10 SHAs(Thereby slashing NHS management costs by
45%)7 Reduce the number of arm's length bodies,
or quangos, e.g. the Health Protection Agency and Human Fertilisation and Embryology Authority
How much will reorganisation cost?
£1.4bn estimated overall cost • £1.024bn redundancy costs:
40% of PCT and SHA staff (20,900 redundancies and 3,600 'natural wastage')
• If 50% leave the redundancy costs rise to £1.288bn
• Some staff will transfer to NHS and LA bodies or Monitor
• Additional £377m:£12.5m for each organisation being abolished£264m on IT and accommodation costs
New English bodies• GP commissioning consortia by 2013• Pathfinder consortia as quickly as possible
(There are now 141 pathfinder schemes, covering around half the English population)
• NHS Commissioning Board • Public Health England • Healthwatch• Foundation Hospitals• Lansley dismissed giving GPs greater powers
over PCTs:• "The abolition of PCTs is simply the
consequence of form following function," he said
Opposition
• The DH has stressed repeatedly its belief that the huge changes it foreshadows will empower patients and improve care
• But last week the RCN conference voted by 99% in favour of a vote of no confidence in health secretary Andrew Lansley
More opposition
• Gives new powers to GPs to start charging for services (Ed Miliband)
• Driven by ideological dogma (RCN delegate)
• Lansley has lost the confidence of the NHS (John Healey, shadow health sec.)
Letting private companies rip
• Public satisfaction with the NHS is high• Although there is acceptance that cut-backs
are necessary there is no call for “reform”
According to Healey:• 5 clauses in the bill cover commissioning• 85 cover turning the NHS into a free market
No one voted for this and Cameron promised to stop “pointless reorganisations” of the NHS “that bring chaos”
What will this mean for IPE?• Fewer NHS staff: greater need for
collaboration, good handovers etc.• Privately run services, as employers as well
as providers• More administrative tasks, more negotiation• Greater and lesser diversity in the student
population: more international but fewer poor students
• Less theoretical learning for teachers
Polictics
• Coalition Government policies mitigated in Scotland, Wales and Northern Ireland by their own administrations
History, tradition and culture
• Not only will there be differences in policy and politics between our countries, but also differences in history, tradition and culture
• And different responses to economic, social and educational policy