1. A borderline debate

    24 Nov 2014

    Cross-border health arrangements between England and Wales are, by most peoples’ standards, a relatively niche administrative issue. Yet such is the level of debate about the NHS in the run up to the general election that the number of patients who are resident in Wales but use English health services recently blew up into a front page spat between the Daily Mail and the...

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  2. The population time-bomb: can NHS spending keep pace?

    19 Nov 2014

    Eighteen months ago, the protection of NHS spending was not a popular position in Whitehall. Other departments, cut to the bone and facing more of the same, were envious. Politicians as different as Vince Cable, from the Lib Dem left, and Phillip Hammond from the Tory right, lobbied hard for the health service to “share the pain”. In Paris, the OECD called on...

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  3. General practice: too tired to change?

    (Guest blogger)
    13 Nov 2014
    Comments: 1

    The unrecognised – and under-celebrated – core of our successful NHS has been the role of general practice. Their registered list of patients has enabled continuity of care, continuity of patients’ records and long-term relationships that build mutual trust. Fortunately, NHS England’s Five Year Forward View has recognised this, with calls for further investments in general practice, as well as more integrated care.

    A modern, forward looking, sustainable and thriving...

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  4. Is general practice really in crisis? Moving beyond the headlines

    (Guest blogger)
    4 Nov 2014

    A sample of headlines about general practice over any seven day period for the last six months would likely describe a service either on the brink of – or already engulfed within – a serious and potentially intractable crisis. 

    The falling investment in primary care has led some commentators to predict in the region of 500 doctors’ surgeries going out of business. 

    Others highlight the demographic split of the GP workforce – with a disproportionate number within five years of viable retirement – and...

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  5. Three key factors for making NHS England’s Forward View a success on the frontline

    31 Oct 2014

    In my clinic last Friday I was shocked: four out of sixteen appointments were taken by patients who were unable to gain access to the hospital services they had been told they needed. Having each tried to contact the hospital several times, they came to me to ask for help in navigating hospital booking systems, for interim pain relief, and reassurance. GP appointments that should have been available for clinical problems were used for administrative support, alongside clinical advice on the symptoms that arose from delays in care.

    ... Continue reading
  6. Over-stretched hospitals: let's improve how patients are met on arrival, not block the front door.

    (Guest blogger)
    30 Oct 2014

    Jeremy Hunt this morning pledged that £5bn worth of Better Care Fund allocations, founded on targets for reducing urgent hospital admissions, will 'change the basic NHS model'.

    Likewise, this year we have had Clinical Commissioning Groups making projections for rapid...

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  7. Local leaders and MPs must embrace NHS England vision

    23 Oct 2014
    Comments: 1

    It’s the report the NHS has been waiting for. 

    Simon Stevens’ vision for the future of how care will be organised and delivered in England is set out in the Five Year Forward View – the first time the arm’s length bodies in the NHS have come together to produce such a report. 

    Just as he did when creating The...

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  8. Is a transformation fund really the answer for the NHS?

    20 Oct 2014

    A number of organisations have been arguing that there needs to be a transformation fund to support change in the NHS.  

    What they are picking up is something that is very noticeable when comparing the NHS to other sectors and to health systems in many other countries – the absence of a banking function or mechanisms to support organisations while they restructure. This is how the asylums were closed and community mental health services developed.  

    Fixing this is important. The process of change is long, often uncertain and will mean that some organisations running...

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  9. Party conference commitments on NHS spending: the unanswered questions

    15 Oct 2014
    Comments: 2

    I am writing this from my hospital isolation room having just had a stem cell transplant that will I hope cure my dysfunctional bone marrow. The transplant and the care that goes with it is a tremendous fusion of compassion, research, pharmaceutical development, attention to detail, dedicated caring professionalism from the unit director through to the receptionists, significant voluntary sector input largely from the Anthony Nolan Trust but also in funding of hospital facilities, and international cooperation.

    There is no suitable donor for me on the UK registry. But the much larger...

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  10. Those worrying about the transatlantic trade deal should look closer to home

    6 Oct 2014
    Comments: 1

    There has been a lot of concern expressed about the planned free trade deal between the European Union and the US, the Transatlantic Trade and Investment Partnership, and the impact it will have on the NHS.

    TTIP seems to combine a number of popular demons in health circles: privatisation, US healthcare, competition and Europe. The fact that the Department for Business, Innovation and Skills is leading UK negotiations on behalf of the NHS might also make those who remember the Working Time Directive nervous.

    So just how big a threat is TTIP to the way the NHS works? The...

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  11. Could health and wellbeing boards really work as a single commissioner?

    3 Oct 2014
    Comments: 2

    When Health and Wellbeing Boards (HWBs) were introduced in local authorities (LAs) in 2012, their original purpose was to improve the health and wellbeing of local communities and reduce inequalities by promoting integration across health, care and other services.

    While this original job description for HWBs did not include a commissioning role, the idea of HWBs as a facilitator of better joined-up commissioning across NHS services, social care and health improvement is rapidly gaining currency. 

    A...

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  12. If only we could focus on the end rather than the means

    1 Oct 2014
    Comments: 3

    My heart sank when we got a glimpse of Labour’s thinking about post-election health policy, with hints that hospitals would be expected to evolve into integrated care organisations providing all health and...

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  13. Facing the funding conundrum

    25 Sep 2014
    Comments: 8

    The future funding of health and social care is arguably the big public policy conundrum of our age. Yet, until now, politicians have been reluctant to address the unprecedented financial squeeze facing both the NHS and social care. 

    Alarm bells have been sounding about the financial health of the NHS for some time now. Back in 2012 we warned of a yawning £30bn funding gap within a decade; earlier this year we warned of...

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  14. Counting the cost of end of life care

    25 Sep 2014
    Comments: 1

    Our health services are not just about our health. They are also heavily involved in our deaths.

    This year, for every 1,000 people in England, nine will die. Eight of those nine will have some hospital care during their final year of life. For four or five, a hospital bed will be their last.

    Unsurprisingly, people who are near to the end of their lives are disproportionately high users of hospital services. We estimate, that approximately 15% of all emergency hospital admissions in England belong to the 1% of people in their final year of life.

    We know that very many...

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  15. More NHS charges? Lessons from history

    (Guest blogger)
    7 Aug 2014
    Comments: 6

    The Health Secretary has quite a difficult job. He is charged with encouraging quality improvements in the NHS while it is, as the Nuffield Trust’s report Into the Red? shows, under considerable – perhaps unsustainable – financial pressure.

    As the new two-part edition of my book on the history of the health service From Cradle to Grave, or the Nuffield Trust’s interactive timeline show; providing a high-quality,...

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  16. The ‘wicked’ problem of access: is the telephone a solution?

    6 Aug 2014
    Comments: 6

    This week a study in the Lancet concluded that phone consultations with patients who request same-day appointments generate additional work for GPs when compared to face–to-face encounters. In some ways, the study provides further evidence for the existence of induced demand – the phenomenon that widening access for health care fuels use – that we highlighted in a recent Nuffield Trust report (June 2014).

    If patients can’t have all of their care needs...

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  17. A good idea? Wait and see

    4 Aug 2014
    Comments: 1

    I'd heard over the weekend that Jeremy Hunt would make an announcement on NHS waiting times today. My sort of thing (see Buzzfeed for details). I was intrigued.

    When I got up, I read this short teaser piece from the Health Service Journal. In a nutshell, Mr. Hunt was giving trusts space...

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  18. Improving cancer diagnosis: is there a better way than naming and shaming?

    30 Jul 2014
    In a drive to improve England’s record on cancer survival, Jeremy Hunt recently announced that he will 'name and shame' low-referring GPs. It’s clear that improving early diagnosis of cancer could improve survival. But it’s not clear how shaming GPs into referring more patients will solve the problem of delayed diagnosis.

    Our study published this week in the British Journal of Cancer sheds some light on this question for bowel cancer. We focused on bowel cancer because we...

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  19. A risk worth taking?

    23 Jul 2014
    Comments: 1

    The concept of predictive risk, or using linked person-level data to identify the patients most likely to have future unplanned hospital admissions, is now firmly embedded in the NHS. Here at the Nuffield Trust we recently held our fifth annual conference on the topic.

    One of the joys of holding an annual event on the same subject is that it provides an opportunity to see how things change from year to year, and it is certainly true that the world of risk stratification has come a long way over the past few...

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  20. The Better Care Fund: no easy way out

    16 Jul 2014

    Nokia CEO Stephen Elop found a place in the vocabulary of austerity-beset civil servants everywhere when he told his struggling company’s staff they stood on a “burning platform”. The phrase suggests that, like a man jumping from a blazing oil rig, managers and organisations can expand the range of what they see as possible if times get tough enough.

    The Better Care Fund was designed to be the quintessential “burning platform” policy. Into this pot of funding, in 2015/16, will go £1.9 billion top-sliced from the budget of NHS commissioners, £1.1 billion of transferred money for local...

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