1. The health of our children, the health of the NHS

    30 Jan 2015
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    While there has been much focus on the challenges faced by the NHS of an ageing population, there has been less discussion at the other end of the spectrum. Children are the adults, and parents, of tomorrow – they represent the future. Their health in childhood is critical to their physical and mental wellbeing later in life. Protecting their health could translate into a healthier, sustainable NHS.

    To that end, ahead of the election, Labour have launched their proposals for public health, which bring...

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  2. The challenge of change in the NHS in Wales

    30 Jan 2015
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    It can’t have escaped many people’s notice that English politicians continue to throw a spotlight on the performance of the Welsh NHS. With Wales the only UK administration controlled by Labour, the Conservative party has consistently sought to highlight the state of the Welsh NHS, perhaps in response to Labour’s comparative political advantage on the NHS in the forthcoming UK election. For its part, the Labour party - both in Cardiff and Westminster – has repeatedly defended its record by claiming it is difficult to...

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  3. Fact or Fiction? Social care cuts are to blame for the 'crisis' in hospital emergency departments

    29 Jan 2015
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    Rising demand for urgent and emergency care is not a new challenge. But in recent months, there’s been a scramble to find explanations for the overheating hospital sector.

    These include (in descending order of credibility) the predictable effect of an ageing population, more chronic illness generally across all age groups, poor access to out of hours GP services...

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  4. Level up: new responsibilities for CCGs

    23 Jan 2015
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    Clinical Commissioning Groups (CCGs) – now approaching their second birthday – are having to grow up fast. They have cut their teeth on community and acute services, and now have the option to take up further responsibilities.

    Up to half of the country's CCGs have applied for full delegated responsibility for commissioning primary care (Level 3). An estimated 10 per cent are likely to opt for '...

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  5. The tail of the long waiters

    16 Jan 2015
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    In August, Jeremy Hunt announced a ‘managed breach’ of two shorter-term (18 week) treatment waiting time targets: the expectation that 90% of inpatient and 95% of outpatient treatments started within 18 weeks of referral. His argument was that this relaxation would give hospitals breathing space to treat people who’ve been waiting the longest (over 52 weeks). They had until December 2014 to sort it out.

    At the time the...

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  6. The Cancer Drugs Fund: An important stopgap

    (Guest blogger)
    14 Jan 2015
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    Yesterday, as part of their blog series on the Cancer Drugs Fund, the Nuffield Trust posted a blog from Health Policy Fellow, Helen Crump, outlining some of the difficult questions surrounding the Fund. 

    The Cancer Drugs Fund clearly isn’t perfect – as Helen points out, it creates a perverse incentive for drug companies not to reduce prices – but it’s far better than what we had before. At a time when the CDF is under...

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  7. We are in a hole with the Cancer Drugs Fund – why do we keep on digging?

    (Guest blogger)
    14 Jan 2015
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    As demonstrated in Helen Crump's recent blog for the Nuffield Trust, the debate around both the merits and future of the Cancer Drugs Fund (CDF) has reached fever pitch over the last month or so following the announcement that drugs not deemed to be of value for money were to be delisted. I do not think anyone should be surprised or shocked about this – it was just a matter of time before this car...

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  8. The Cancer Drugs Fund: a question of value(s)

    13 Jan 2015
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    NHS England’s announcement yesterday on the future of the Cancer Drugs Fund has reignited an important debate about how to understand ‘value’ in relation to NHS services.

    In the coming days, guest bloggers from two cancer charities, Macmillan Cancer Support and Myeloma UK, will be sharing their views about the fund and its future....

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  9. What’s behind the drop in A&E performance?

    9 Jan 2015
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    Earlier this week there was a sense of panic in the air as a number of hospitals declared ‘major incidents’ and missed their waiting time targets. It’s a response somewhat out of proportion to the scale of the problem – while performance is among the worst it has been in the last decade, it’s still high by international and longer-term historical standards.

    What has actually been happening?

    A number of explanations of what has been going on have been offered this last week, but they don’t all add up. So let’s start with some facts.

    A growth in raw numbers

    ...

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  10. 2014: A one year backward look

    19 Dec 2014
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    Healthcare has continued to dominate the news and public policy agenda throughout 2014. From the growing sense of crisis in general practice to mounting concerns about the solvency of NHS organisations, the NHS and social care look set to dominate the 2015 General Election.

    And as Simon Steven’s Five Year Forward View continues to play a central role...

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  11. Festive cheer? Alcohol and the NHS

    18 Dec 2014
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    During Christmas party season the effects of excessive alcohol consumption may cause headaches, and not just for those who overindulge. Our health and public services will also suffer.

    As well as the harmful short-term consequences of alcohol we should also be aware of the harmful long term consequences of alcohol to health – such as increased risk of liver disease, stroke, dementia and some cancers.

    While we know a bit about the individual costs of these long-term consequences...

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  12. Pharmacists as care givers can make the forward view come true

    17 Dec 2014
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    Listening to reaction to the chancellor’s Autumn Statement on 3 December, anyone would think that Simon Stevens’ NHS Five Year Forward View was no more than a clearly made case for more money for the NHS.

    But the cornerstone of the forward view is the new models of care that will unlock change in the NHS: from GP networks becoming large scale community services providers, to district general hospitals as hubs of new accountable care organisations.

    Outside Westminster, the report has opened up a...

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  13. Prevention is better than a cure

    15 Dec 2014
    Comments

    I grew up listening to my granny saying “prevention is better than a cure”. Follow that with a career in public health, and NHS England’s Five Year Forward View is welcome reading. It makes prevention and stronger advocacy for public health powers in local government key priorities for the NHS.

    Some might argue that the NHS does not have the time, energy or resources to forge an assault on prevention given the current challenges. I would argue the NHS cannot afford not to.

    An investment worth making

    Prevention...

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  14. Thirty years, little progress: women in NHS management

    11 Dec 2014
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    In 1987, like generations of NHS graduate management trainees, I made my way to Harrogate for the two-day assessment that determined which bright-eyed and bushy-tailed graduates would be admitted to the national scheme. I can still recall how surprised and impressed I was that the final appointments panel was chaired by a woman chief executive, and that she took time during the interview to talk to me about the NHS’s opportunities and support for women managers.

    Bear in mind that, at a similar interview for the then British Rail scheme, I had been asked why ever a woman would be...

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  15. How pharmacy could save the NHS

    (Guest blogger)
    9 Dec 2014
    Comments

    I read Amit Bhargava’s recent blog with interest – among many other pieces on the financial pressures facing the NHS, and the recruitment pressures facing GPs. The one that affected me most was a blog by a female GP who faced burning-out under the stress of it all and ended up with a silent breakdown.

    I believe a crisis is imminent, if not already upon us. One local GP practice has...

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  16. Volunteering in the season of goodwill

    8 Dec 2014
    Comments

    A straw poll of my work colleagues revealed that, like me, many think more about doing nice things for others in the run up to Christmas. Volunteering falls squarely under this heading, and is the focus of a piece of evaluation work currently being undertaken by the Nuffield Trust.

    In addition to a recent evaluation of a scheme run by the British Red Cross, the Trust is currently ...

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  17. Beyond the blueprint: are bespoke solutions the future of the NHS?

    5 Dec 2014
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    It is obvious to the point of cliché that NHS providers are experiencing challenging times. But while some are struggling, others are faring better in this difficult climate.

    Although similar problems (decreasing tariff levels, costly private finance initiative contracts and recruitment challenges to name a few) affect multiple providers, the consequences providers experience will vary depending on factors such as the state of the local health economy, and the shape of the organisation.

    What makes perfect sense as a solution for one provider can seem utterly implausible or...

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  18. An army of the willing?

    3 Dec 2014
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    There is an increasing interest in the role that the voluntary sector, and in particular volunteers, can play in supporting delivering better health and care services – something recognised in the Five Year Forward View. We have just published an analysis of one such scheme run by the British Red Cross, which has a significant role played by volunteers.

    The work of...

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  19. A borderline debate

    24 Nov 2014
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    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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  20. The population time-bomb: can NHS spending keep pace?

    19 Nov 2014
    Comments

    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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