Category Archives: Politics, Policies And Process
Health Services Or Public Transport, The Contractual Issues Are The Same.
PFI contracts are again in the news, as the London Underground Northern line grinds to a halt and no-one knows who to hold accountable. But what does this also tell us about private (and social entreprise) service provision which is bought in by NHS and Foundation Health Trusts? Private sector buy-in contracts need careful thought if they are to deliver what is expected, no more, no less. So who is going to provide this legal scrutiny?
”No-one, it seems, is in charge…. London Underground needs a simple line of control and responsibility and does not have it…. In truth the problem is not the involvement of profit-making companies in the underground, but the terms on which they are involved and at present these are failing badly.’ Thus runs the Guardian’s second editorial today.
Just two days ago (this website, NHS Contracts and Foundation Hospitals: Who has the Legal Expertise?) I predicted that issues around PFI would continue to run, and that the problems which have plagued PFI contracts would in all probablity also plague new Health Service arrangements. It didn’t take long to see that unfortunately there is indeed mileage in this prediction.
The NHS is now taking financial management very serously indeed. How long will it be before there is similar attention to matters contractual? Significant external commercial partnerships are a fairly new development in the NHS, which has almost always previously provided its own in-house services.
Much has been made of the political implications of private service providers being involved in the NHS, but I wonder whether the same reservations would be applied to social enterprise involvement? If the answer is No, social entreprise involvement is alright, but private sector provision is not, then perhaps we have our eyes at least partly on the wrong ball if we simply dismiss the idea of buy-in as such?
Given the complexities of modern technolgies and economies, does it matter where the service comes from, as long as it’s good, in budget, well-delivered and properly accountable and managed?
It’s the management and accountability issues which are critical – and it’s here that NHS and Foundation Trusts need to think very carefully. They are accountable, and they need to manage.
There are an awful lot of smart city lawyers out there. We must be sure some of them are on the public service side when it comes to negotiating health provision contractual arrangements.
Cherry Picking Liverpool’s Sefton Park Agenda
Liverpool’s Sefton Park has beautiful cherry trees, at present under contentious threat of being demolished. Why not, instead, use this situation as a way to engage local people, especially children, in ownership of their local (and often greatly under-appreciated) green space, and of the natural cycles which must always occur?
Unsurprisingly, there’s much consternation in Liverpool at present about the fate of the cherry trees around Sefton Park‘s middle lake. For some, they look like worn out relics of their former glory, due for the chop. To others (me included!), they are still wonderful, showering their landscape with gorgeous pink blossom for those special few weeks in the Spring.
But all things do come to an end, so ultimately the trees will have to go. The question is, when? Why can’t new trees be planted and allowed to blossom forth before the ‘old’ ones at last become wood chip?
An under-valued community resource
Sefton Park is situated in what is genuinely the inner city ‘donut’. It is surrounded on most sides by areas which include many children who lack first hand knowledge not only of parks, but also even of how things grow. It is also a hugely under-valued urban resource; a situation which hopefully will be much improved by the new, long overdue, proposals to revamp the park as a whole.
It’s not an especially original thought, but is there some way that the new trees could be ‘owned’ by children in different school classes or clubs? Or indeed from different surrounding streets?
Recycling trees and art?
Then, when the new trees have grown, the ones they are replacing could finally become part of the recycling process, with all this entails being explained in due course to their replacements’ ‘owners’.
Perhaps, even, some of the ‘old’ trees can be carved or otherwise used to represent aspects of our local lives? (So many trees are already being cut down, doubtless for good reason; but where are the sculptors and artists who can put their remnants to good publicly visible use? – and cherry wood, I understand, is particularly fine for this, when eventually it comes to it!)
Engaging people in change
People find it hard to accept change. Here, if there’s someone or some organisation willing to deliver it, is a way to help local folk engage positively. Why have a fight about something as beautiful as cherry trees, when so much else should be taking up our energies?
See also: Sefton Park’s Grebes And Swans
Liverpool’s Sefton Park, Swans, Herons And Grebes
Sefton Park, Liverpool: Winter Solstice 2006
Cherry Blossom For May Day In Sefton Park, Liverpool
What Now For Liverpool’s Sefton Park?
Liverpool’s Sefton Park Trees Under Threat – Unnecessarily?
Solar Lighting Could Solve The Parks Problem
Friends Of Sefton Park
NHS Contracts and Foundation Hospitals: Who has the Legal Expertise?
Is it actually the contracting out to private (or indeed social enterprise) suppliers for some NHS services which should be of most concern? Or is it the exact nature of the contracts agreed between NHS Trust Boards etc and their suppliers which requires the most scrutiny? There may be details here which make all the difference to what happens in the future….
Foundation Hospitals present us with a bewildering array of issues, on which much time and energy has been expended. There is one aspect of this development, and of the ‘contracting out’ of services in other NHS Trusts (to private suppliers, or indeed to social enterprises) which apparently perplexes me more than it does many others.
I don’t necessarily have a problem with ‘buying in’ at least some services, which for whatever reason an NHS Trust may not be able to provide; but there could be a problem if control of the service somehow thereafter eluded the Management of that Trust. Is this a medical or, rather, a legal matter?
How much training and expertise do public sector managers have in developing contracts with private companies? Is this a field in which most public sector staff could – or indeed until till now should? – have significant experience?
If a private contractor provides satisfactorily exactly the service which has been agreed, in the way and for the price agreed, perhaps there is no real problem; but is there a risk that sometimes this may not occur and either
(a) there will be no legal redress, or
(b) there could be loopholes which might enable the private contractor to have a hold on service provision which is greater than that envisaged?
In either of these cases there is the risk of compromise of the basic tenets of the NHS. Perhaps therefore it would be more useful to examine precisely what NHS Trusts and private suppliers agree, than to make a big thing of the idea of contracting out for specialist (or whatever) services as such. Some have suggested that these details were at base the ‘real’ problems with PFI. It is to be hoped, if so, that they are not repeated in the implementation of current proposals.
The devil, I suggest, is in the detail rather than in the ideas themselves. It will be interesting to see what specific expertise NHS managers acquire (or have already acquired) in these legal matters, as we move ahead. There is no doubt a tale or two as yet to be told about these complex propositions.
US Universities, Privatisation And ‘Intelligent Design’
Universities in the USA are increasingly funded by private interests. This has already raised curriculum concerns, especially for instance about ideas such as ‘Intelligent Design’. Anything which is at base an attack on scientific method and, indeed, rationality, should be watched very carefully indeed.
Public funding of universities in the USA has fallen further since 2001 than at any other time in the past two decades, according to the New York Times today (74% in 1991, 64% in 2004). Some university presidents are therefore becoming vocal in their concerns about ‘public higher education’s slow slide toward privatisation’.
The concern is in part that private funders set an agenda not always in tune with public universities’ wishes. These centre on teaching, autonomy in research and time spent securing private funding.
Could this be a particular problem in the context of so-called Intelligent Design? This is the notion, akin to ‘creationism‘, that somehow the human race has emerged in just a few thousand years, after being ‘designed’ by… who? Yet this unlikely thesis – with absolutely no credible basis in evidence or scientific theory – is increasingly being pressed upon American schools, for inclusion in their curricula. Apparently this is to ‘balance’ Darwinian theories of evolution.
Buying beliefs?
So what is the link with university funding? Well, presumably not all funders are scientifically well informed; such knowledge is by no means a necessary prerequisite of huge wealth or of a desire to influence what others know and learn.
Some observers of American science have wondered why more outstanding scientists do not speak out loud and clear about this attack – for such it is – on scientific method and, indeed, rationality. But the reason why seems clear: they don’t want to rock the boat when it comes to funding.
The price of academic autonomy
Never has there been a clearer case for academic autonomy, away from the beliefs of those who do not appreciate what sturdy, contestable peer review is all about. Peer scrutiny is not perfect – one is reminded of the slogan (was it Joseph Schumpeter’s?), ‘Two Cheers for Democracy!’ – but it is the best we can currently come up with, and all genuine universities need to continue to keep as far as possible from undue influence.
In the modern world of macro-economics not every bit of science can be influence-free. Creeping privatisation of public higher education is, however, one area where extreme caution is required.
Liverpool’s Alder Hey Hospital May Move To Widnes
Alder Hey Children’s Hospital in Liverpool has now formally announced that it may leave the city for Widnes, because of a local reluctance to supoprt plans for necessary expansion. Widnes doubtless has many attractions, but it cannot claim proximity to other internationally claimed medical institutions amongst them. Liverpool’s decision makers must wake up very soon indeed to the need to understand the critical importance of Big Science – which includes leading hospitals – to their local economy.
It’s now official: Liverpool’s Alder Hey Hospital, world leader in paediatric medicine, may have to move from Liverpool to Widnes because of local resistance to their plans to expand on the current site – even though there is a clear undertaking by the hospital to provide a well-planned and maintained ‘children’s health park’ within the extension proposals.
Let’s be clear. Alder Hey is NOT proposing that all the trees be cut down, and that they ruin a beautiful piece of parkland. The current park is truly nothing to be proud of; but the proposed new children’s health park would surely be. Indeed, it could, like its organisational base, be a shining example of how health, environment and education can come together.
Full marks to Widnes for spotting an opportunity which it seems has passed Liverpool by; but even Widnes itself presumably does not list amongst its attractions proximity to a world-class Medical School and the Royal Liverpool Teaching Hospital (see article on this website, 12 October).
Is Big Science also the last Big Secret, an invisible commodity which decision makers and planners at the local level just don’t see for what it is? Put together the budgets of the Royal, Alder Hey, the Medical School and, e.g., the Liverpool School of Tropical Medicine and you have a sum larger than that of many medium-sized towns – and an employment requirement which is hugely important to any local economy.
Let’s by all means assure local residents that they will get their trees back. (Maybe we also have to persuade the Council for the Protection of Rural England, who perhaps have a particular take here?) But let’s also show a bit of grown-up leadership.
Widnes can of course have its fair share of the deal – Alder Hey already has proposals for a number of service delivery sites around its area, called ‘Alder Hey at…’. Patient access is always a prime consideration; but that doesn’t just apply to Widnes.
In the end it’s in no-one’s interest to break up the personal and professional connections which have over the last several decades been carefully established by the practitioners working in Liverpool’s great hospitals and university.
It looks at present as though there is a lack of ‘scientific literacy’ of a very basic sort in the considerations of local decision makers. They don’t actually have to understand the science itself, but they certainly need to try very conscientiously to grasp the simple facts of scientific life: at base, there’s no synergy without connectivity – which includes opportunities on a day-to-day basis for outstanding medical scientists and practitioners to get together.
And, if this isn’t enough of an argument, who’s going to accept responsibility for the hundreds of less skilled hospital jobs which will go elsewhere, in one of the most disadvantaged parts of an already economically challenged city, when and if this absolutely unnecessary dispersal of international expertise occurs?
Where Have All The Gardens (And Allotments) Gone?
There are many unattended back gardens in cities; but there are also many people who would like to have allotments. Could these two observations be brought together to provide a sense of place and an opportunity for city children to learn more about things that grow?
If, like me, you travel on trains quite a lot, you also see quite a lot of back gardens. Some are beautiful; some are not. One striking thing however is that the beautifully kept gardens seem to be contagious – on each side there are usually tidy gardens, gradually petering out to the less tidy, and then to the frankly unkempt. I have always been fascinated about how this happens. Perhaps visible example enables achievement, just as in any other area of human experience?
It has to be said, however, that quite a lot of the unkempt back gardens tend to be inner-city. Yet at the same time there are reports in some places that waiting lists for allotments are at an all-time high. Can’t these back gardens become ‘allotments’? And maybe ‘parks’, too?
Are there areas where people might be pleased to get rid of their battered fences, at least at a given distance from their actual houses, and turn these into pleasant shared ground? Alleygating of terraced housing has in general proved to be popular. If alleyways can be shared to advantage, how about gardens?
Promoting environmental awareness through gardening
Maybe there are people who would like to have their allotment as an extended patch behind where they live, as long as they don’t mind sharing.
Are there any organisations which might encourage this sort of collective gardening activity? Could there be educational as well as community benefits? Maybe that way fewer city children would believe that peas are manufactured in tins. And maybe also those in a given ‘garden community’ who wanted to move beyond their immediate backyard into shared garden space might have a safer place than the street to meet as neighbours.
This idea naturally begs a lot of questions, and there are multiple reasons why it might not work, but perhaps there are also some why it might.
Can Digital Technology Meet The Challenges Of Social Inclusion?
New technology, particularly email and the worldwide web, has many benefits to offer almost everyone. But it fails to reach many who would find it useful, principally because of its complexities and unfamiliar style. Perhaps we need to think about a ‘Library of the Web’ as a way of offering a level of guarantee of acceptability in terms of content, and to adopt a Plain English Campaign-style approach to e-tech presentation.
There is plenty of evidence that the worldwide web has helped people to make contact across huge divides; but the debate continues (see Guardian letters today) about whether on overall balance it contributes, or does not contribute, to social inclusion.
Essentially, the most serious techno-divide seems not to be between people of different ages or of, e.g., different genders, but between those who are willing and able to get to grips with new technology and those who are not.
Email can be a great boon for people who are housebound, as well as home-workers and of course those in employment. Websites can provide the most amazing information. In every case however there has to be a facility in both the physical and the attitudinal senses.
We can make simple e-tech equipment for young children; why not also for people (some of them older, some with physical difficulties, or whatever) who have difficulties or concerns about using it?
We can ensure that what children read is acceptable and generally valid information. Can this not be done on some level, in terms of public information for everyone, about how to check what you are reading has some substance? Libraries on the whole manage to do this for the books they stock. What about a ‘Library on the Web’ of some sort, maybe at varying levels of provision?
Employment opportunities and training are quite rightly becoming much more accessible on line; so should opportunities for people to seek help with their health concerns, citizenship concerns and much else. These things do exist, but by no means as accessibly as many of us would like.
There is a widespread need to engage people who DON’T understand new technology in its production, when this is for general use, and especially when it’s intended as a public service. (We all pay for public service information; and there is anyway an irrefutable case for making sure we can all, or as many as will benefit from it, have genuine access to it.)
Much of e-tech is produced by people who find it difficult to see how perplexed many of the rest of us are by their language and modes of communication. The real challenge which faces them is to use their skills, at least for pubic domain e-content, to achieve the same level of presentational simplicity as that required, say, to operate domestic appliances or read a popular newspaper.
Social inclusion and entitlement continue to be pressing issues as the internet grows apace. Where is the equivalent of the Plain English Campaign, when it comes to the new technology?
Threat to Liverpool Arts Press Coverage?
Liverpool’s leading morning newspaper is reported as intending to cut back significantly on its Arts coverage, which will it is claimed no longer only be ‘ghettoised’ on one page. How does this fit with Liverpool’s forthcoming status as European Capital of Culture 2008? And will the same rationale now be made for rescuing Sport from ‘ghettoisation’?
It seems that Liverpool is about to reduce its newspaper Arts coverage substantially. A report in the UK Press Gazette on Thursday (13 October) suggests that daily coverage in the city’s leading ‘serious’ paper is to be reduced from five to two days a week, the Friday art supplement is to be eight, not sixteen pages, and three paid columnists will be axed. The rationale is apparently that the Arts will no longer be ‘ghettoised on a specific page each day’.
There also seems to be a suggestion that this change is somehow linked with increased sales and prices.
Confusion exists about exactly how this reduction in specific coverage will be aligned alongside the claim of all concerned to be supporting Liverpool’s European Capital of Culture Year in 2008. If reporting and reviews of cultural events are cut, this must inevitably have an effect on readers’ awareness of cultural activities in and around the city – which includes a readership area reaching out to Chester, North Wales and parts of Lancashire.
It is likely that, in the possible absence of expert opinion on arts topics, only a small part of Liverpool’s cultural offering could be covered; and almost certainly those organisations which stand to lose out the most (alongside their patrons) are the smaller, specialist arts organisations.
When we also read that Sport is not to be ‘ghettoised’ on particular pages, perhaps the case for rescuing the Arts from such a fate will be more convincing.
What Priority For Liverpool Hospitals As Part Of The Northern Big Science Community?
Liverpool’s leading university hospitals are at risk of physical dispersal at exactly the same time that eight top universities across the North of England are trying to find ways to build their scientific synergies. The implications for Liverpool of the threat of dispersal seem so far not to be appreciated.
The news today is patchy. On one hand, we learn that the Northern Way has appointed an eminent cancer specialist to lead the N8 consortium, a scientific collaboration led by the University of Liverpool between eight universities from the North of England.
Called the Northern Research Partnership, the N8 consortium is a collaboration between Durham, Lancaster, Leeds, Liverpool, Manchester, Newcastle, Sheffield and York, which between them generate more than £620m per annum in research grants. N8 is concrete evidence that the three regional development agencies in the North of England are now actively getting their scientific act together.
Yet also today we read in the local paper that plans to expand the Royal Liverpool University Hospital on its present site – a project which has secured £500m of funding – may not be going ahead because the will is may not be there to find another way to take forward the local council’s £12m Hall Lane bypass scheme, which is part of the intended improvements to the City-M62 link route.
Add to this the apparent reluctance to secure huge improvements on their current site to Alder Hey Children’s Hospital, and you do begin to wonder if the city understands that these hospitals are places of learning at the cutting edge of international research, as well of course as places where people can receive first class medical care.
It’s far less important for the future to allocate responsibility for who said what about these proposals, and when, than it is to find a way forward.
These hospitals need to be linked closely with the university and the Medical School; they need to nurture their community of practitioners; the ‘common room / photocopier’ effect is crucial here. If people at the cutting edge are dispersed, there is a danger that their impact will be likewise weakened; and there are also enormous implications here for investment and big business in Liverpool.
If eight universities across the whole of the North of England can recognise the benefits of getting together, surely there is a way, before it’s too late, that two hugely important Liverpool hospitals and a Medical School can be enabled in a much more intimate physical setting to do the same?
High Culture, Regeneration And The Legitimation Of Excellence
In some circles it is a given that High Culture is ‘inappropriate’ for ‘local people’. This is patronising. It dismisses the enjoyment the arts can bring to everyone, and ignores opportunities which the arts – as particularly visible public activities – can give for people to develop skills and even careers. Legitimation of ambition, in the arts or any other challenging positive activity, is important, regardless of where you live.
In a city such as Liverpool, there is for some a major issue about entitlement and appropriateness in respect of culture. It has on occasion been suggested that ‘high culture’ is not what should be on offer to local people, because they don’t / wouldn’t enjoy it.
This approach surely misses the point. Art must always be inclusive, but like many other activities, getting well acquainted requires patience and perseverance. All cities, and many smaller localities, need to offer every level and type of culture – and here is a challenge for developers as much as for community leaders and politicians – if they are to be true cultural centres, convincing and alive.
The case for a broad sweep in cultural provision is convincing. The argument that ‘high’ art is unnecessary because ‘people don’t want it’ is at best patronising, and at worst insulting, both to providers of that art and to its potential recipients. There must be opportunities for artists to offer their skills at the highest levels of achievement, alongside programmes which afford people engagement in the arts at lesser formal levels of skill (whether this be performing themselves, or listening / watching / looking at the work of others).
One of the challenges in this for regeneration is to find out how to knit together these opportunities, sometimes using the same human and cultural resources, and sometimes different ones, in a way which moves forward for all concerned. When this happens there will be more positive ‘artistic’ and professional role models for others in a given community to follow, which would help to ensure that local aspirations are high and that people from less-advantaged communities are not just left expecting the low-paid jobs.
Put another way, community perception of the art of the possible – expectations for the future – must include legitimation of the ambitious.
In the light of these considerations, perhaps there should be a re-emphasis within the questions above, at least to include these questions:
* How can decision-makers and leaders nurture formal arts and culture in places with limited understanding or appreciation of these?
* How would this impact in terms of enhancing engagement and opportunities for both arts practitioners and their ‘audiences’ / local people?
* What would be the cultural, social and economic synergies which follow from such enhancement and engagement?
Such questions in no way imply that everyone has to appreciate ‘high art’. What they might do is bring us to a greater consideration of the value of art and artists ‘for themselves’ as well as for what they can deliver in the normal sense of regeneration.
Regeneration plans must include artists directly, alongside all other partners. In including them directly we might even discover a new narrative to describe the meanings of ‘high art’, and what can come from it…
Dreaming Realist 