Nuffield Trust continues to lead on a range of research projects that are helping the NHS respond to the major challenges ahead. In whatever we do we aim to promote improvements in the quality of health care and policy-making in the UK. Ultimately, we aim to ensure that our evidence-based research and analysis, recommendations and tools are adopted by policy-makers and practitioners.
We know that it can be difficult to assess the impact of an organisation’s research activities, but we believe we can demonstrate real impact in a number of key areas, as outlined in the following case studies:
Person-based resource allocation (PBRA)
This project, funded by the Department of Health, has had significant impact on the way in which budgets for commissioning care are estimated and allocated to general practices. Our previous work on PBRA – led in partnership with the University of York, Health Dialog, New York University, London School of Hygiene & Tropical Medicine and University of Manchester, has already been adopted by the Department of Health. The results were incorporated into the national ‘fair shares’ formula allocating resources to general practices from April 2010 under practice based commissioning.
As a result of our work in this area, we have been commissioned to update and refine the models for future allocations to shadow GP commissioning consortia. We are also looking into the important related question of how financial risk is shared appropriately across commissioners. This intelligence will feed directly into policy-making in the future.
Predictive risk modelling and data linkage
We have continued to develop predictive risk modelling techniques which utilise our innovative data linkage techniques. Our work, to link health and social care data, is recognised as being at the forefront of data linkage techniques. Information from this work is already influencing the Department of Health’s strategy team as well as the National End of Life Care Strategy, including the national review of palliative care funding. The extent of the overlap in the use of health and social care by individuals has been widely quoted, for example in reports for the Care Quality Commission and NHS Information Centre.
Our data linkage work is helping us to develop tools to predict the individuals at high risk of requiring future care and support so they can be offered targeted, preventative care. Such tools can lead to better care and a more efficient NHS. Our work in this area includes developing a model to predict high future use and cost of social care by individuals, and an analysis of social care and hospital use by large groups of individuals at the end of life, commissioned by the Department of Health.
We recognise the ground-breaking nature of the research. The results were very promising and we know that predictive risk offers the future possibility of population risk assessment, cost-effective prevention and early intervention.
Paul Burstow MP, Minister of State for Care Services, on our data linkage work to develop tools to predict individuals at high risk of requiring future care and support.
As a result of our work on predictive risk modeling, we are now regularly in demand to use the techniques developed at the Nuffield Trust to evaluate the impact of interventions to help reduce avoidable demand and the costs of care. The evaluation of the Department of Health-funded whole system demonstrator sites is the most comprehensive evaluation of telehealth in the world. Nuffield Trust is leading on the study of how these technologies impact on the use of health and social care services. In addition, we are undertaking a series of studies using a highly innovative technique to match cases with control groups.
The evaluation work undertaken at the Nuffield Trust has been acknowledged by the Department of Health as being particularly important in shaping thinking about the Department of Health's view on the right approaches to delivering care and managing long term conditions.
I write to inform you of the value of the interim reports you have produced on hospital utilisation for people on the WSD. We have been keen to see the impact of the significant investment in WSD prior to formal publication of the results. Your reports will help us as we discuss at policy level how best we plan for post WSD.
Stephen Johnson, Head of Long Term Conditions, Department of Health, commenting on our forthcoming report: The impact of Telehealth and Telecare: Evaluation of the Whole System Demonstrator Project.
UK and international comparisons
Our study: Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution provided the best available, independent, comparative study of UK health care performance. The report received widespread interest in Parliament and the media but, more importantly, revealed critical inconsistencies in data collected across the UK by the Office for National Statistics, which the Nuffield Trust helped to resolve.
Our research led MPs and senior civil servants to question the absence of accurate comparable data to allow differences in performance across the UK to be analysed in depth. As a result, the Nuffield Trust is the leading independent health policy organisation on UK health comparisons. The research will be repeated in 2012 and all UK nations have agreed to participate in the data collection process.
Analysis of health care reform
We are regularly called upon to provide expert policy analysis, which is rooted in our rigorous research evidence. For example, our analysis and commentary on the NHS reforms outlined in the Government White Paper: Equity and Excellence: liberating the NHS, led to us being invited to give both written and oral evidence to the Committee of MPs set up to examine the Health and Social Care Bill. While the Health Select Committee also called our experts to provide oral evidence to their recent inquiries into commissioning in the English NHS. We are regularly cited in Parliament and in Government policy documents.
The Coalition Government's NHS reforms: an assessment of the White Paper report was absolutely excellent. Not only do I agree with almost every detail but it was brilliantly pithy and readable. I think this is brilliant placing of the Nuffield Trust between the academic and theoretical and being strictly practical and communicating to those who will be part of the change.
Dr Michael Dixon, Chairman, NHS Alliance.
Commissioning and integrated care
One of the most wide-ranging aspects of the Government’s reforms to the NHS in England will see the transfer of responsibility for commissioning the majority of NHS services from PCTs to GP consortia by 2013/14. We are part of the national evaluation of the Department of Health’s integrated care pilots and are also carrying out a major two-year study of the practice of commissioning care for people with long-term conditions. Our thought leadership on the future of commissioning has led to invitations to give evidence to the Health Committee and approaches from NHS commissioners and GPs to help them think through how best to respond to emerging policy, including at Trafford, Plymouth, UCL Partners in North London, and in a new GP commissioners’ network.
Our work has been fed into the Department of Health primary care and commissioning policy team, national bodies representing GP consortia and general practices, and the Treasury Health Team where it continues to influence emerging policy.
In addition, one of our strengths in this area has been to examine international best practice in countries such as the US and New Zealand where doctors’ groups have experience of holding the equivalent of commissioning budgets. We have been successful in examining different approaches to commissioning and bring back useful lessons for policy-makers and practitioners in the NHS in England. Our research into the experiences of doctors’ groups in the US in particular has been cited in Parliament, including by MPs on the Health Bill Committee.
One of the most interesting pieces of evidence that we have been presented with was the Nuffield Trust report about the US experience. That is relevant, because it states that: “English GP consortia will really struggle unless there is a relentless focus on securing and sustaining high-quality leadership and substantial investment in management”.
Grahame Morris, MP for Easington and Member of the Health Bill Committee, on our report: GP commissioning: insights from medical groups in the United States.