24 June 2005
The NHS has improved markedly over the past few years, but more attention needs to be paid to public health problems such as obesity, sexually transmitted diseases and especially mental health, Baroness Julia Neuberger told the conference.
The former chief executive of the King's Fund praised the creation of the Healthcare Commission and the introduction of national service frameworks.
'One has to give ticks in the box for all that, and the mega-investment that is taking place is great for all the people who work in the service,' she told CIPFA delegates.
But she labelled mental health services a 'disgrace', especially acute inpatient services.
'Wards are violent places to be. There is open drug dealing, open use of weapons. It's an unacceptable situation,' she said.
'The system is frightening for both patients and professionals. It is a huge blot on our NHS landscape.'
Neuberger was joined on the platform by Simon Stevens, president of UnitedHealth Europe and a former health adviser to the prime minister, who agreed that the NHS was improving.
But he said there needed to be more creative thinking about the demand for health care, which better matched services to need. The purchaser mechanism also needed to be sharpened up, Stevens said.
'When it comes to sorting out the purchaser function, practice-based commissioning will help, but it's not what we need,' he said. 'Practice-based commissioning is likely to fail at a time when we need the purchaser function to be more assertive because of changes on the supply side.'
In response to a question from the floor on what could be done to overcome negative public attitudes about the NHS, Neuberger said part of the problem was sections of the media that always attacked the NHS.
But she added that the health service itself could do more to publicise its successes. 'It's partly us not telling the story right,' she told delegates. 'More could be done to publicise evidence from the Healthcare Commission's survey that show patients are relatively satisfied.'
Help us to combat poverty, World Bank financier urges
A senior member of the World Bank has urged the accounting profession to play an increasing role in combating global poverty.
Addressing CIPFA delegates on June 16, Tony Hegarty, regional manager for financial management at the World Bank, said his organisation recognised the 'crucial role of the accounting profession in international development'.
Hegarty said solutions to poverty had always been crucial, but were made even more necessary following the September 11, 2001 terrorist attacks in the US, because there was a growing realisation that the issue was also linked to global security.
Hegarty linked public sector work in this area with Chancellor Gordon Brown's campaign to reduce debt and to improving accountability of political leadership in the developing world.
'The interests of people in all countries would be best served when the scourge of poverty is ended,' Hegarty said.
He praised CIPFA's work in helping to construct transparent accounting frameworks in the developing world, which he claimed could help to improve governance and promote the efficient and effective use of public services internationally.
But Hegarty added: 'Daunting challenges remain. The number of people in sub-Saharan Africa living on less than $1 per day, for example, has risen.'
He urged accountants to play their part in making effective use of the World Bank's planned increase in aid and debt relief, and in dismantling barriers to trade.
Graham Ward, president of the International Federation of Accountants, had earlier told the audience: 'You are at the front line of keeping all governments accountable and responsible and in putting the public interest first.'
Benn believes in more local accountability
Councils should be given powers to develop services as they see fit, provided they can secure the backing of the communities they serve, veteran Labour politician Tony Benn told the CIPFA conference.
'If a local authority can persuade people to give them the money to do something they want to do, I don't see any reason why they can't do that,' Benn told delegates during a packed closing session.
He also urged politicians to have the courage to raise taxes in order to pay for decent public services.
In an entertaining speech, Benn provided a potted history of the public services from medieval times until the present day. He praised the emergence of democracy, which had transferred power from the 'marketplace to the polling station' and led to the creation of the welfare state.
But Benn criticised some recent developments, particularly the application of business terms, such as 'customer', to the public services and the growing influence of regulatory bodies.
'Regulators have taken over the business of government,' he said. 'League tables are a strange way of measuring performance and have the effect of demoralising people. Those who succeed parade on a platform of failure.'
Look to the future, Mulgan tells managers
Public sector managers should adopt a more systematic approach to innovation, a former senior adviser to Tony Blair told the CIPFA conference.
Geoff Mulgan, director of the Young Foundation and former head of the Number 10 Policy Unit, said the public sector needed to test out its own future more.
'Most public sector managers cannot say what their strategy for innovation is. But it is only by doing things that you learn what works.
'We need to be more global in outlook and learn from countries that do things better than us,' he told delegates on June 16.
In a session on the likely shape of public services in 2020, Mulgan refused to make firm predictions, but suggested that there would be a more holistic approach to big outcome goals, such as crime reduction and better health. But he added that the pace of change would be slow.
'I fear that the joined-up government strategy is still in its infancy,' he said.
Mulgan added that some as yet unforeseeable factors might also influence the direction of travel.
The conference also heard from Tony Travers, director of the Greater London Group at the London School of Economics, who predicted a much more mixed economy of provision, with public sector managers fulfilling new functions as co-ordinators of a complex web of public, private and voluntary sector providers.
'A public service management role will be responsible for the choreography of services, determining levels of service provision and overseeing quality of output and outcome. The public provider will act as the guarantor of universal provision,' he said.
Travers added that public services had changed radically in just a few years and managers had had to learn to evolve.
'Pluralism' key to regenerating cities
Liverpool City Council chief executive Sir David Henshaw has urged other public bodies to restore civic pride to the UK by realising ambitious and lasting regeneration schemes.
Henshaw, one of the key architects of Liverpool's re-emergence as a thriving city and high-performing local authority in the late 1990s, addressed CIPFA delegates on June 16, urging them to 'take individual responsibility' for regeneration plans.
He said Liverpool, and other successful regenerated cities such as Birmingham, proved that it was possible to restore local residents' pride in their locality and in public organisations, but warned that it does not come easily.
He said local authorities must first build a 'new pluralism' in the delivery of public services by engaging with other public bodies, the private sector and voluntary organisations to undertake and complete regeneration projects.
'If the public sector, and local government in particular, are serious about pluralism, then we have to learn to be led at times. Councils must build partnerships and show belief in the ability of those partners to successfully deliver their side of the [regeneration] bargain.
'Sometimes it will be uncomfortable, challenging and hard, but my belief is that is how regeneration is achieved.'
But Henshaw also warned that regeneration must start with core services, and not just new projects. 'If you can't pick up the bins properly and effectively, you can't do the highbrow strategy work,' he warned.
Lin Homer, the outgoing chief executive of Birmingham City Council, criticised past regeneration programmes across local government as unsustainable and 'short-termist', because they were based on a 'weak economic agenda' and the failure of councils to 'punch their weight'.
Homer instead called on authorities to group together into city regions to develop regeneration plans, such as transport networks, that benefit communities across political boundaries.
Linking urban regeneration plans with her forthcoming role as director general of the Home Office's Immigration and Nationality Directorate, Homer added: 'Immigration is going to be an increasingly big issue for lots of cities and regions. I would like to think that my part of the Home Office would listen and work with you in helping to deliver solutions to any problems.'
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