Monday, 17 December 2012

Liverpool Care Pathway - The Micawber Principle

The Problem . . .

This is LGiU (Local Government Information Unit) -

Civil Society Innovation

Councils are in the process of fundamentally changing models for service delivery – to respond to the significant budget savings that need to be made and also because some of the toughest problems that councils and communities are facing require a radically different approach.
Much has been said about the concept of the ‘Big Society’; some councils have wholeheartedly embraced this concept, and others have been more tentative with terminology. In both cases, local authorities around the country are finding innovative ways to engage citizens and civil society in the design and delivery of public services in order to innovate.
LGiU are bringing together local authority leaders, with DCLG, Ministers and civil society stakeholders to highlight the good work that councils are doing in driving forward innovation, explore new models of service delivery and also think about how councils can move forward with the challenges ahead.
Lead Contact: Laura Wilkes -

Difficult Financial Outlook

Birmingham City Council will be opening the consultation for the 2013/14 Budget next

month against a backdrop of greater than previously notified grant reduction from 
national government.

Total cumulative savings requirements to 2016/17.


Over a six-year period from 2010/11 to 2016/17, the forecast total Government grant
will reduce by £332m. At the same time, we will need to fund unavoidable cost
increases due to the effects of inflation, the changing basic needs of our population,
changes in legislation and financing costs. These are expected to cost £273m extra
by the end of 2016/17, meaning that we will have to make savings of over £600m or
more by that time – that’s around 48% of the total spending over which the council
has control.

   Council Budget

Making savings and meeting demand for our services

Making savings
The Council needs to make savings of £12.8million in 2013/14, including an extra £6.9million to fund increasing demand for some services.
£3.8million of efficiency savings and suggestions to raise more income have been proposed. A further £9million in savings has also been recommended through changing the way the Council buys goods and services.
Meeting the demands of our changing city
Like you, the Council has only a limited amount of money to spend. Faced with significant changes to the city's population, the Council will need to invest more money on services for vulnerable people.  In particular:
  •  more people are living longer
  •  elderly people need increased support as their needs become more complex
  • additional care is required for people of all ages, including support for people with mental illness, learning disabilities and dementia
  • we have less money to spend, but face more demand for our services.

The Solution . . .

This is LGiU (Local Government Information Unit) -

Civil Society Innovation

A Good Death: the role of the local authority in end of life care

Few of us like to talk about dying. Despite the fact that death is a universal prospect for all of us, we often shy away from discussing the topic – uncomfortable to share our fears, let alone our hopes or expectations.
We do know, however, that most of us would prefer to die at home. Research shows that 70 per cent of adults would like to be cared for and die in their own home [1]. But the great majority of us still die in hospital, and only two out of ten are able to remain in their homes in their final days.
Whilst in recent years there has been progress within the health sector, with the NHS publishing its End of Life Care Strategy in 2008, the engagement of local authorities has been more mixed. This is significant because many local authority services, such as social care and housing, are crucial components when delivering high quality end of life care.
With this in mind, we recently published a report with Home Group, A Good Death: the role of the local authority in end of life care (PDF document), which examines the role of local authorities in end of life care provision and considers how councils can best develop their part in this important service provision.
As part of research, we surveyed 91 upper tier councils. Our survey revealed some interesting findings:
  • Six out of 10 respondents thought that their existing end of life care arrangements would not be sufficient in future.
  • Four out of 10 thought that Health and Wellbeing Boards should lead on end of life care in future. However, only three out of 10 said that their shadow health and wellbeing boards had identified end of life care as a priority.
  • Only a quarter of respondents said that housing departments were engaged with social care on end of life care issues, despite the often crucial role of housing in supporting quality of life outcomes.
Our report highlights how a lack of collaboration between local agencies leads to more people dying in hospitals, rather than in the manner they choose.
This trend can, however, be reversed. Councils, with their new convening powers through the Health and Wellbeing Boards, are ideally placed to bring together health, social care and housing. Our report therefore calls for councils to take ownership of the end of life care agenda in order to enable people to spend their final days in dignity.

Taking Learnings . . .

Don't flounder in the problem; fish for a solution...

To take some sound advice... 
“‘My other piece of advice, Copperfield,’ said Mr. Micawber, ‘you know.  Annual income twenty pounds, annual expenditure nineteen nineteen six, result happiness. Annual income twenty pounds, annual expenditure twenty pounds nought and six, result misery.”  David Copperfield - Charles Dickens
This is the Micawber Principle - "Something will turn up."

What’s ‘turned up’ is something more of the moot of a Uriah Heep than a Micawber!

This is Wilkins Micawber, a man with a common spark of decency:
Welcome poverty! Welcome misery, welcome houselessness, welcome hunger, rags, tempest, and beggary! Mutual confidence will sustain us to the end!” 


  1. The claim that the NHS requires cuts of £15-20 bllion to survive and that the blame for this resides with the obstinate clinging to life of our older, weaker, disabled or chronically ill citizens, is nothing less than a huge and discrimnatory lie.

    UK's per capita spending, or proportion of GDP spending, on health care is substantially less than that of many other countries.

    In my opinion, it's not the sick and elderly who are a burden on our society, it's a large section of our greedy, self seeking, wasteful, squandering and too often inept political class and heaving public sector that demands gold plated salaries and pensions all paid for by hard working people in the private sector, whose own, far smaller salaries and pensions and whose health care are being cut, cut, cut.

    Those of us who are not directors of giant corporations, bankers with ponzi schemes or members of the overpaid political and public sector class are, like Micawber and the Dorrits, banged up in the Marshalea debtors' prison by the out of control financial engorgment of these greedy sectors. They are the ones who are clinging to an economically unsustainable status quo, not the rest of us,