1. The nitty gritty detail of integrating complex systems

    17 Apr 2014

    Recently, on one of my clinical general practice days, I made 21 phone calls to a London hospital trying to leave a message asking a consultant to call me urgently. A patient I had seen at 9am had decided not to have a disfiguring operation for a cancer that was planned for 10 days later.

    I needed urgent advice about the options for reconstructive surgery so that I could have an informed discussion with her during the following week about the choice she had made. Had she understood the facts about her condition? The consequences of refusing treatment? Time was of the essence: I...

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  2. Beyond the politics: the truth behind the UK health systems

    11 Apr 2014

    Criticism of the Welsh NHS is a popular sport for English ministers. David Cameron takes regular pot shots at longer waiting times and failure to hit A&E targets.

    To the politically cynical, it looks like a straightforward attempt to brand Labour, who governs in Wales, as a party that cannot manage the NHS.

    It may also be an attempt to show that the ‘English’ approach to managing the NHS, with the development of a market, competition and a variety of private, voluntary and other providers, is producing better results than that in Wales which abolished...

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  3. I have to readmit – it’s getting better

    (Guest blogger)
    7 Apr 2014

    Hospital readmissions for emergency care have been the subject of policy attention for a few years. The common view is that they are preventable by a better standard of care; however the reality is much more complex.

    Our research, published in the Emergency Medicine Journal, throws some light on this reality.

    We looked at 83 million hospital admissions in England using data sets spanning all NHS hospitals over a 10 year period. The team looked at patterns of readmission within 30 days, at an individual level. These large data sets make it...

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  4. Houston we need a solution: time to stop describing the problem

    3 Apr 2014
    Comments: 2

    My start at the Nuffield Trust coincides with the anniversary of the new system and Simon Stevens’ first week in charge of NHS England.

    I’ve been spending time on international work for the last two years and have been somewhat concerned by the nature of the debate on health and social care recently.

    The first reason is that there is too little public discussion about the solutions to the financial challenges facing social care and the NHS.

    There is a shared view that 2015/16 is going to be tough. We also...

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  5. Influencing GPs and the expanding role of Clinical Commissioning Groups

    1 Apr 2014

    Since clinical commissioning groups (CCGs) moved into the driving seat of the commissioning system 12 months ago, the breadth of the job they are expected to do has become apparent.

    Responsibility for each of the big changes we are increasingly told that the NHS needs – better joint working with social care, further efficiency savings in hospitals, and radical change in the scale and scope of general practice – rests largely on the shoulders of CCG leaders as the key drivers of change.

    It is the last point – the involvement of...

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  6. The other care crisis: disabled people are also feeling the squeeze

    (Guest blogger)
    26 Mar 2014
    Comments: 1

    The new report from QualityWatch (a joint research programme from the Nuffield Trust and Health Foundation) is another reminder that the social care system is on its knees.

    The number of people receiving care – working age disabled people and their carers, as well as older people whose case is so powerfully made in this report – is being rationed, leaving thousands of people previously eligible without any local support.

    The Government’s flagship...

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  7. How to make Monitor the ‘people’s champion’

    (Guest blogger)
    24 Mar 2014

    Frontier Economics hosted a roundtable discussion at the recent Nuffield Trust Health Policy Summit to discuss the development of economic regulation.

    We drew some (only some – yes, health care is different) inspiration from the experience of other regulators. The early days of Postcomm – the postal regulator overseeing a government-owned Royal Mail – provided some lessons.

    Postcomm reached for the standard regulatory toolkit but found itself foiled by a publicly owned Royal Mail who accumulated losses year on year. Sound familiar? In the end the...

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  8. Are the wheels finally coming off the NHS' finances?

    20 Mar 2014
    Comments: 7

    While this week’s Budget contained no new announcements on health spending, it shone a harsh light on just how tough the financial challenge is proving for the English NHS.

    The chart below from the Office for Budget Responsibility (OBR) shows how Government spending on the English NHS is falling as a share of UK GDP – from 6.5 per cent of GDP at the end of the last decade to 6.2 per cent in 2015-16. Health spending as a proportion of GDP last fell in the late 1990s and before that in the late 1970s – in both cases to be followed by major programmes of reform...

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  9. The big freeze: is the NHS pay deal fair?

    19 Mar 2014

    Today’s Budget contained no new announcements when it comes to health and social care. While the continuation of austerity beyond the next election will almost certainly mean more tough decisions on public spending in the next spending review, today was all about warming up to electorate for the election with eye-catching policies on tax and pensions.

    The big news as far as the NHS is concerned had already been announced: last week the Government set out its decision on NHS pay over the next two years.

    NHS staff in England who receive incremental pay award will not have any...

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  10. 10 top tips for managing difficult service change

    (Guest blogger)
    14 Mar 2014
    Comments: 1

    “It constantly surprises me that my colleagues don’t recognise the power of personal leadership”.

    This is one of the quotes from a study of successful service reconfigurations. All across the economy leaders have to change services – often asking users to accept different modes of delivery for financial reasons. But across the NHS, some manage it well, whereas others effectively blow their toes off one by one with a shotgun.

    Why? One is assuming that the public and colleagues are rational, and once they realise the basis of your sensible arguments, they will go along...

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  11. Working at change: responding to the Francis Inquiry

    (Guest blogger)
    4 Mar 2014

    MBA students in the United States are now taught about the Mid Staffordshire NHS Foundation Trust Public Inquiry as a case study of institutional behaviour when leaders lose sight of their values. Will they one day also use the Care Quality Commission (CQC), as a case study of just how fundamentally a failing institution has to change?

    I know it’s stating the obvious, but I’m still amazed at how wrong decisions about the direction of an organisation (that are often relatively quick to make) can take literally years to turn around.

    Last week the CQC...

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  12. Summit’s up: issues for the 2015 election

    26 Feb 2014
    Comments: 1

    Just over a year to go to the next election and we are all in for a prolonged bout of campaigning. Come next March we will probably all be bored, waiting for it to be over having made up our minds. So now is the best time to get a sense of what will be coming – and our annual Health Policy Summit next week will offer some clues.

    Call me a wonk if you like, but I’m looking forward to Philip Collins reviewing the political scene and Jeremy Hunt and Andy Burnham strutting their stuff, along with further debate from Rt Hon Stephen Dorrell...

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  13. Can payment reform promote better care?

    (Guest blogger)
    20 Feb 2014
    Comments: 1

    The NHS payment system defines the mechanisms through which NHS-funded care is paid for, and the prices paid. These mechanisms and prices are levers available to commissioners to incentivise providers to achieve health care objectives, such as better health outcomes, activity targets, greater efficiency, and reduced waiting times.

    For example, the “Payment by Results” system, through which hospitals are paid according to how much treatment they provide, was introduced to incentivise more hospital activity, at a time of long and growing...

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  14. After the Francis Inquiry: are we more aware of care quality?

    (Guest blogger)
    18 Feb 2014
    Comments: 3

    When opening the Nuffield Trust Francis one year on conference, Rt Hon Stephen Dorrell MP described the second Francis Inquiry Report as a ‘seminal event that needed to become a transformative one’.

    The Nuffield Trust report: The Francis Report: one year on states that hospitals have taken significant heed of Francis, and have focused in many and varied ways on care quality, compassion, complaints, nursing and openness and transparency.


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  15. Openness should be in the DNA of every hospital

    (Guest blogger)
    6 Feb 2014

    Four years ago I published a report laying bare the shocking care provided at Stafford Hospital. I heard of an elderly patient left naked in public view covered in faeces, of another who died because she not given insulin, of wards where elderly patients were not helped with food and drink, of an A&E where waiting times were fabricated.

    Staff who raised genuine concerns were not listened to or respected, and...

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  16. Is the NHS a safer place a year after the Francis Report?

    6 Feb 2014

    Imagine that today, February 6 2014, you’ve just said goodbye to your elderly mum or dad, looking small, lost and confused in a hospital bed. They’ve been admitted after a fall at home and you’ve been told they’ll be in for a few days, and not to worry because they are in safe hands.

    But you do worry, because you remember reading all those stories about what happened in Mid Staffordshire Hospital. You worry about whether, at 2am in a darkened ward, there isn’t something similar going happen to your mum or dad, if they won’t be...

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  17. Got a problem? Call 118

    30 Jan 2014
    Comments: 3

    The Care Bill seems to be passing through Parliament with barely a ripple. Except for Clause 118. This is the clause where the Government is taking the opportunity to ‘clarify’ the law surrounding the Trust Special Administrator’s powers to drag other trusts into the frame when considering what to do with a failing one.

    It stems from the successful judicial review over the proposed closure of Lewisham Hospital’s A&E department as part of the Special Administrator’s plans to deal with the...

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  18. Under pressure: hospital organisation in Europe

    (Guest blogger)
    29 Jan 2014
    Comments: 2

    Hospitals across Europe are under pressure. They all tend to have business models which rely on growing income and payers that are increasingly trying to contain them.

    Big questions are being asked about future strategy but there is surprisingly little public debate about this important part of the health system and there is insufficient policy analysis.

    Our recent European Summit brought together leaders and analysts from across 16 countries to compare notes. This revealed some interesting differences...

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  19. Informing the public on information

    17 Jan 2014
    Comments: 27

    Most of the services we receive nowadays (be it internet shopping, high street banking or health care) have a trail of data associated with them. We’ve come to expect that these trails will be used to help future interactions be more efficient for us and/or those providing the service.

    This applies as much to public as private sector services – though we’ve also come to expect that the public sector lags well behind the private sector when it comes to IT matters.

    In many cases this perception of the public sector is probably true (any luck making a GP appointment online...

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  20. Come again? What the data tells us about repeat A&E visits

    9 Jan 2014
    Comments: 5

    The BBC’s research, published yesterday, on frequent users of A&E makes for interesting reading. They found that nearly 12,000 people made more than 10 visits to the same unit in 2012/13, and a small number of those attended more than 50 times. This is an eye catching finding and it is important to consider what those numbers might actually mean.

    While the 200,000 attendances used by people attending A&E more than 10 times a year is a big number, it represents just a tiny fraction of the 14 million total attendances at...

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