1. Will co-commissioning deliver on its promises?

    1 Apr 2015
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    Today marks the launch of primary care co-commissioning between NHS England and the majority of CCGs. These plans support the current direction of travel that aims to see more care being provided in the community as well as services and (perhaps) commissioners integrated. However, for the CCG leaders trying to turn these policy intentions into reality, the pressures facing both commissioners and general practice providers suggest that life is going to get harder before it gets easier.

    What does this mean for how likely it is that co-commissioning will deliver on its promises?

    ...

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  2. Getting the most from evaluation

    31 Mar 2015
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    There is an awful lot of interest in evaluation at the moment – no bad thing for us at the Nuffield Trust, given that we have a long track record in certain types of evaluation.

    Most recently, NHS England have said that the new Vanguard sites, new models of care described in the Five Year Forward View, will need to show “a commitment to co-design local and national metrics and to demonstrate progress against them, including...

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  3. Fact or Fiction? Reconfiguring hospital services will deliver significant savings

    25 Mar 2015
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    This blog is part of a series called ‘Fact or fiction?’, where experts from the Nuffield Trust give their take on the data and evidence behind some of the current perceptions of what is happening with the NHS.

    NHS hospitals are under mounting financial pressure. A common belief is that the reconfiguration of hospital services, primarily through rationalising services across sites and shifting services into the...

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  4. Can the NHS help tackle the UK’s obesity epidemic?

    20 Mar 2015
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    “Obesity is the new smoking”, said Simon Stevens, Chief Executive of NHS England. “It is a slow-motion car crash in terms of avoidable illness and rising health care costs.”

    Is he right? And if so, can the NHS help work towards solutions, or only tackle the associated health need?

    How big a problem is the obesity epidemic?

    According to estimates from Public Health England, two thirds of adults...

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  5. A starting gun or shot in the dark?

    (Guest blogger)
    19 Mar 2015
    Comments

    In a sequence of events, that could only be dreamt of (up) by election pundits, Simon Stevens announced the day before NHS Change day that his Vanguard programme will support “radical care redesign….for patients across England”. But did he really ‘fire the starting gun' or is this simply another shot in the dark?

    Let us be in no doubt. The health and social care system has never faced such critically challenging times. The usual way of delivering...

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  6. The voluntary sector: ready, willing and able

    (Guest blogger)
    18 Mar 2015
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    Ahead of the launch of our fourth Health Leaders Survey tomorrow, Dr Jane Collins, Chief Executive at Marie Curie and member of the panel blogs on the role of the voluntary sector in the NHS.

    People often talk about the role of the voluntary sector in the NHS as though this is somehow a new or unusual thing, but actually Marie Curie and many other voluntary sector organisations have been around for as long as the NHS – some longer – and have proven expertise in delivering high quality care and support.

    People also often talk about services provided by...

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  7. US healthcare reform: Lessons for the UK

    (Guest blogger)
    16 Mar 2015
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    As we near the fifth anniversary of the signing of the Affordable Care Act (ACA), it is an important moment to reflect on what the ACA has accomplished, which challenges remain and how we might move forward. The lessons of the ACA, especially from the Accountable Care Organizations programs, have important implications for the UK NHS and their efforts to improve integration, delivery, and quality of care provided.

    What does the Affordable Care Act aim to do, and how?

    The ACA is two laws in one: an act to improve access to...

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  8. Fact or Fiction? Declining hospital performance is down to a few ‘bad apples’

    13 Mar 2015
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    This blog is part of a series called ‘Fact or fiction?’, where experts from the Nuffield Trust give their take on the data and evidence behind some of the current perceptions of what is happening with the NHS.

    We know national performance in many key NHS hospital targets has been declining for a while – indeed it’s nearly impossible to go a day without hearing about the pressures facing A&E and its ‘four-hour target’. Recently, this apparent deterioration has spread beyond...

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  9. NHS research ethics approval: Open to interpretation?

    10 Mar 2015
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    Research is key to providing evidence for best practice in healthcare. The current system of approvals and permissions for conducting research in the NHS presents a number of practical challenges, most noticeably navigating the complexities of the system and overcoming the inconsistencies that can be encountered.

    Few would argue with the need for some sort of ethical review of research in the NHS – protection of patients under NHS care is paramount. There is a clear duty of care that exists, particularly when research involves potentially vulnerable populations like children.

    ...

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  10. The way the NHS manages A&E problems is not fit for purpose

    6 Mar 2015
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    In researching the recent problems in accident and emergency performance, I was struck by the way the NHS is managing the situation: there appears to be a large amount of activity across the system – conference calls, emails, phones calls – to check progress and request detailed information.

    Is this adding value or causing problems? What were those involved hoping to achieve? And why is this type of activity thought to be an important...

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  11. ‘Devo Manc’: Small steps, great leaps

    5 Mar 2015
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    The bold proposals to transfer responsibility for Greater Manchester’s health and social care needs to accountable bodies in the region were the talk of our annual Health Policy Summit.

    This reflected two very contrasting themes that were evident at the Summit. At one end of the spectrum, there was a focus on micro-level improvements that have the potential to add up to major change. At the other end, were discussions of big structural changes needed within the NHS.

    Micro-focus, major impact

    One change approach...

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  12. Fact or fiction? Demand for GP appointments is driving the ‘crisis’ in general practice

    3 Mar 2015
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    This blog is part of a series called ‘Fact or fiction?’, where experts from the Nuffield Trust give their take on the data and evidence behind some of the current perceptions of what is happening with the NHS.

    Headlines and stories about the ‘crisis’ in general practice have become commonplace over the last year or so. A demoralised and squeezed workforce is struggling to meet the needs of increasing numbers of patients demanding immediate appointments. Or so the narrative goes.

    There are mounting concerns that patients unable to get an appointment...

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  13. A patient perspective on self-care

    (Guest blogger)
    25 Feb 2015
    Comments

    Having Parkinson's since I was 13 has made me an expert in self-care

    When I was 13 years old, I experienced the first symptoms of what almost 20 years later would be diagnosed as Parkinson’s disease. Getting Parkinson’s in your teens is pretty unusual, if not rare. Nevertheless, I am happy that I wasn’t diagnosed with an “old person’s disease” in my teens. I am convinced that if I had known when I was 16 that the problems I experienced with movement, gait and balance were due to Parkinson’s, I would not have gone to university, got my driver’s licence or dared to start a family...

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  14. The NHS is in an era of opportunity; let’s not lose sight

    24 Feb 2015
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    Would you go out on a hazardous journey, with barely enough food to survive on, and with no map or compass? It could be argued that this is precisely what has been asked of the NHS since funding stopped keeping pace with our country’s rising health and social care needs and the Health and Social Care Act undermined the strategic leadership of the NHS. 

    It is no surprise then that the Five Year Forward View has been welcomed with open arms. It begins to fill the strategic vacuum and signals a direction that speaks to core...

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  15. Fact or Fiction? The NHS has too many managers

    19 Feb 2015
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    This blog is part of a series called ‘Fact or fiction?’, where experts from the Nuffield Trust give their take on the data and evidence behind some of the current perceptions of what is happening with the NHS.

    It’s election season, and NHS managers and 'bureaucracy' are once again in the firing line. The Coalition boast of putting “more money on to the front line and less into management”; Labour and its...

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  16. MPs will always be part of the rationing equation

    (Guest blogger)
    18 Feb 2015
    Comments

    Most people can accept that, in any cash-limited system, there will be some things that cannot be funded. However, translating this relatively simple, if abstract, concept into a practical and defensible process is challenging.

    Rationing is probably not a very helpful term to describe the difficult decisions health services face about potentially denying people care that their doctors think they need. In the UK when we think of rationing we tend to think of the World Wars.

    However, food rationing was predicated on people needing (roughly) the same amount to survive. The...

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  17. Rationing: An unhelpful term for the broader issue of prioritisation

    (Guest blogger)
    18 Feb 2015
    Comments

    Clinical commissioning places general practitioners at the heart of local health planning. As clinicians, we want to ensure that we provide every service our patients want, and that every health intervention comes with the necessary aftercare and support.

    There are, however, two important additional factors:

    1. CCGs have a set financial allocation to purchase these services
    2. Some interventions are ineffective for some patients

    Funding for the NHS as a whole is a political decision, made nationally and determined by national economic factors. Each CCG...

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  18. Fact or Fiction? Targets improve quality in the NHS

    13 Feb 2015
    Comments

    This blog is the third in a new series called ‘Fact or fiction?’, where experts from the Nuffield Trust give their take on the data and evidence behind some of the current perceptions of what is happening with the NHS.

    Views on targets are highly polarised. Special interest groups are keen to get a target for their priority area while detractors question their clinical validity and assert that care has become 'all about meeting targets'; a sense of achievement abstracted from meaning. Yet in the past targets have been associated with dramatic improvements in...

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  19. Mortality rates: getting the right measure

    13 Feb 2015
    Comments

    The Secretary of State has recently announced an annual review of the case notes of 2,000 people who have died in hospital every year. The purpose of this is to identify how many deaths could have been avoided through better care quality – and presumably find ways to identify and implement change where care falls below standard. 

    Although we hope that hospital care improves our chances of survival, we also know that simply counting deaths is misleading. For me there are three underlying issues:

    1. Why not use the...
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  20. Managing doctors, doctors managing: Troubled relations at the heart of the NHS

    (Guest blogger)
    6 Feb 2015
    Comments

    Two years ago today, Robert Francis QC published his report into the failures of care at Mid Staffordshire NHS Trust. The report found that one of the contributing factors was a focus on finances at the expense of patient care within the trust.

    In this election year, the NHS is bending under what is in effect a frozen budget, while trying at the same time not to lose its focus on patients. Cracks are beginning to show. We don’t have to look too far to see...

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