The new government scrapped the plans for free personal care, but then confirmed the ring fence that ensures real terms increases for health spend included the free personal care money. This meant the DH has been sitting with £400m burning a hole in its pocket that was going to be spent on social care, but is health money.

It got me thinking that this is just an example of the impossible position in which social care finds itself – precariously perched between looking towards the rest of the council and looking across the health and care system.

I think many people assume that social care sees a problem with the ring-fence as it means an unfair distribution of financial pressures. The ring-fence has been laid across the middle of a whole range of activities trying to join the two sides together. It is the barrier being there that is causing a problem, not the fact that those one side may have more financial pressures than on the other.

I believe that fundamentally social care directors don’t want to integrate or align better with health to get their hands on NHS money, because social care is an essential part of the health and care system and anything they do has to take in to account the whole system.

Jeremy Cooper, director

Based on the recent rhetoric, there may be a number of reasons for this as I see it:

Firstly, the government is trying to reduce the wage bill of senior public officials.  In reality this initiative is likely to have the opposite effect, as to fulfil a broader range of functions mayors will be paid more, and are likely to employ a chief of staff to manage and co-ordinate operational activity on a day to day basis.  Possibly not the smartest way to reduce the size of the public purse.

Alternatively, there may be a belief that executive mayors may be better at leading an organisation on a operational basis? This suggests a dissatisfaction with the performance of current chief executives. However, we need to ask how well qualified or experienced are mayors in running some of the most complex organisation in this country?  Maybe we should focus on tackling the elephant in the room - the real issue of how to improve the operational management  in public services.

Or, could we be trying to professionalise the political role in local public services. This action could distance the relationship the mayor has with the community, and brings into question relationships with other local politicians.  Surely there are better mechanisms to improve the political infrastructure where this is necessary?  What is more important is that government have a far more effective way of scrutinising performance and intervening where services are unsatisfactory or poor value for money.

Finally, the government could be trying to achieve greater local accountability in the delivery of public services.  But such a move may blur the lines of accountability to the public and remove the vital independence that officers have in the management and delivery of services.

Mr Pickles should look to those areas where mayor and chief executive relationships work best, for example in Hackney where we have seen some of the most remarkable improvements in local public services.  So soon into a new administration, are we really this short of new thinking that a reshuffling of deck chairs is needed?  Gimmicks just won’t work.  Instead, the Government needs to work with the sector to reshape services and implement localism, where co-production of services with citizens and other agencies is the norm rather than the exception.

Martin Cresswell, chief executive 

Establishing a sense of urgency

Lansley has ticked the box on this one and gives a very clear message that he has done his homework, formed his thinking and has set the stage for change. He sees that the business-as –usual is not acceptable in the NHS and in some respects is” making the status quo more dangerous than launching into the unknown”

Forming a powerful guiding coalition

The new ministerial team are in place and roles agreed but to be successful, the ministerial team has a pivotal role in growing the same drive and commitment from a wider pool of leaders and stakeholders to ensure that there is a sustained critical mass of supporters and followers.  This has yet to be tested during the journey.

Creating and communicating a vision

Clear elements of the vision are there in the White Paper and the strap line “no decision about me without me” sets the tone for the future. The picture is painted of a patient-centred NHS, more choice, more frontline control, more focus on clinical outcomes, a more market driven healthcare system. The destination is clear with some unchartered waters to get there.

Getting rid of obstacles to change

This is where the debate around policies, the levers in the system, current organisational forms and incentives becomes very interesting. The reality is that there will never be alignment with financial, performance or delivery mechanisms in the system before the change starts but the key is to know which ones to change and when. Has the structure button been pressed too soon or is it really the main obstacle to achieving change?

Creating short-wins and declaring victory too soon

At the moment this is the area where it is hard to see any signs for success. It is hard to see  any productivity or performance gains  or increases in patient satisfaction over the next 12 months. The short win of reducing management costs might be judged as a success for an external audience but to those working inside the NHS or for patients the benefits may be difficult to see or feel.  There has to be some short term wins to be used to build credibility for the bigger, more challenging issues ahead.

Anchoring the changes in the culture

It might possibly be a first if the NHS is really given the one direction of travel and the time to get there. If patients and their families, staff and politicians really do see and feel new behaviours rooted in social norms that support freedom, fairness and responsibility then the White paper will have been a success. The urge to take short cuts or change route makes this seem like never-neverland.

 Liz Howarth, assistant director, iMPOWER

The same questions of responsibility and recompense face George Osborne as he puts the finishing touches to this week’s budget.  We all know the financial crisis was created by the reckless actions of a few, yet the consequent ‘age of austerity’ will affect us all.  The notion is simple – a crisis has occurred, we all need to pay, no-one can or should be unduly protected from the process of recompense.  Yet there is something unsettling about the narrative.  The paradigm of cuts is becoming so powerful it could define the way in which we think about public services for the medium term.  The powerful themes of personalised services and stronger communities may give way to a ration book agenda of less for less where top down cuts are made without reference to bottom-up need.

At iMPOWER we believe – like many – that public services can be much better and much, much cheaper.  The fiscal gap is unarguable and needs to be bridged, but the way we build that bridge is our collective choice.  We can make everything worse for everyone, or be smart by targeting scarce resource where it really matters.   We can choose to cut existing budgets or rethink our budget strategy completely.  We can close facilities or find ways to make the same facilities raise their own income.  And we can provide worse services or give the money to citizens to build new kinds of services.

It is hard to imagine now, but some good may come from the disaster unfolding in the Gulf of Mexico.  It could provide the turning point in our love affair with oil – the moment we begin to step up the challenge of cleaner fuel alternatives.  And so with our reaction to George Osbornes’ budget.  Less money does not always equal less progress.  In making our collective recompense the financial calamity in our public services could, just could, become a triumph.     

Alex Khaldi, director, iMPOWER

Salaries are spiralling out of control, and fees are going up, but have we forgotten the core roles of good business?

The Evening Standard recently reported (May 24^th) that the big four consulting firms had amongst the highest numbers of staff looking for new jobs – we must ask why.

Is it because some have forgotten that staff are their most important asset, and that they must be treated with respect,  dignity and fairness in what is a people based business?

Is it because they are, in principle, disillusioned about the benefit their work delivers to clients – delivering endless strategies, or endless project management assignments?

As consultants we have a responsibility to our clients.  A responsibility that means we listen to them – they know what their problems are after all - we offer constructive challenge and help them realise their ambitions.

iMPOWER creates an environment where we strive to inspire our people, which in turn inspires our clients.

Inspiration in my eyes is not all about money – it is about culture, it is about being proud of what you do, it’s about making a difference.

The conclusion that needs to be drawn from this is that our clients have a choice; they have the freedom to decide.  They want people who are committed to their industry and issues, and if they are not getting what they want from the perceived market leaders, they can and will take their business elsewhere.

Martin Cresswell, chief executive