Nuffield Trust Blog

With the showers has come a certain malaise tinged with queasy uncertainty.

This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with respect to the mass reorganisation outlined in the now Health and Social Care Act.

The queasiness extends beyond health, look at local Government for example facing an average six per cent cuts rather than a ‘flat real’ settlement as in health.

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The introduction of the Health and Social Care Act 2012 was trumpeted in some quarters (including, apparently, the Cabinet room) as a hard-won victory for Andrew Lansley and his plans to ‘liberate the NHS’.

For the battalion of health service managers, however, the campaign has now begun in earnest. It is they who have to take the legislation, translate its complex clauses into practical plans, and determine how far Lansley's hopes will be realised and the fears of his detractors proven or not.

NHS...

The Chancellor made no announcements on the future of the NHS in his 2012 Budget statement. Yet, the contents of the Budget report have quite profound implications for NHS funding.

They also reveal some interesting facts about the short-term.

Short-term movements

According to the 2010 Spending Review, the Government planned to spend £105.9 billion in 2011-12 on health in England. In Budget 2012, that total is now £900 million less.

While £400...

We’re all familiar with the challenges facing the NHS: the tightening budgets, the ageing population, the rising tide of chronic disease and how we organise services to provide a coordinated and seamless experience for complex patients.  What is perhaps comforting is that we are not alone.

At a recent conference, the Canadian Health Services Research Foundation (CHSRF) brought together 150 chief executives of various health providers from across the country to discuss these exact issues.  They were kind enough to...

Annual per capita growth rates in acute care costs are increasing fastest for older adults.

Given that this growth rate is expected to continually increase, it is imperative that we increasingly focus our efforts around developing new cost-conscious models that are also able to meet the complex needs of older patients.

The biggest problem is that our current hospital care model was developed years ago when most adults tended to not live past 65 or were living with chronic illnesses and usually only had one active problem that brought them to hospital.

While things still...

The Nuffield Trust’s fourth Health Policy Summit opens on Wednesday, bringing together senior health leaders, clinicians, policy-makers and academics. The timing is not auspicious.

The intense political wrangling over the Health and Social Care Bill has spilled out beyond Westminster and is dividing professionals in the NHS. Even at this late stage the Bill’s passage through Parliament is uncertain.

Whatever you might think of the Government’s proposals, the financial challenge that predated them is now a reality for the NHS. It is also rapidly becoming...

The NHS Trust sector is now forecasting a surplus of just 0.1 per cent of income in 2011-12, with seven NHS Trusts alone forecasting an operating deficit of over £180 million combined. This is a marked deterioration from previous years and casts further doubt over the sustainability of many NHS Trusts.

For a great many Trusts seeking solutions to entrenched financial problems, the preference has been to merge into ever bigger units. The notable exception being Hinchingbooke Hospital, where the private health care provider Circle takes...

Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".

The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.

When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need...

I got an encouraging letter from the Secretary of State responding to our and The King’s Fund’s analysis on how integrated care could be developed in England. Our publication and other bits are a synthesis of what we know, with some concrete suggestions on how to move ahead.

There is now a tailwind, and the Department of Health, NHS Commissioning Board and Monitor are currently mulling over how best to respond. More on this in the spring.

Meantime, for those weary of Kaiser and Torbay as examples, The Commonwealth Fund this...