1. It's not what you do, it's the way that you do it

    21 Feb 2012

    A centre-right coalition Government; an unsustainable hospital sector needing reform; an ageing population living with more chronic disease; calls for more integrated care; and a belief in the power of local clinical leadership to bring about such change. Sounds familiar? Well, up to a point.

    Here in New Zealand, where Carol Black and I have been taking part in the Royal New Zealand College of General Practitioners' Quality Symposium, you have to pinch yourself, such is the commonality of much of the debate about our...

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  2. Keeping patients' trust

    (Guest blogger)
    17 Feb 2012
    Comments: 3

    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...

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  3. NHS reform, wherever next?

    14 Feb 2012
    Comments: 4

    Andrew Lansley's woes are multiplying by the hour this week as efforts mount to block the Health and Social Care Bill.

    Resistance might be expected from the British Medical Association (BMA) and the Royal College of Nursing (RCN) and other unions, but it is now more widespread and even reported from deep in his own party, among cabinet colleagues. The public are bewildered and staff in the service doing a difficult job while debate rages and the...

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  4. International experience highlights need for payment reform in the NHS

    31 Jan 2012
    Comments: 2

    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...

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  5. Learning from the Alternative Quality Contract

    17 Jan 2012

    A key challenge for NHS commissioning is to develop a ‘golden thread’ between commissioning decisions and changes in the behaviour of front-line professionals.

    Over the years, we have found many ways to achieve this at the margins, for example through commissioning additional services, creating financial incentives or leading service redesign initiatives. But we have not yet found a way to weave that golden thread through the whole health and care system.

    In her recent presentation at a...

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  6. NHS hospital efficiency: closing the gap

    12 Jan 2012
    Comments: 1

    The main question raised by our newly published research report: Can NHS hospitals do more with less? is why, when so much is known about what drives and can improve hospital efficiency, is there still so much variation across, and sometimes within, individual hospitals?

    The areas highlighted for action read like the contents list of a textbook of health care management, with topics such as: ensuring that length of stay and day case rates are in line with international best practice; exploring ways of using new technology to improve hospital...

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  7. If integrated care is the answer, what is the question?

    5 Jan 2012
    Comments: 2

    This is a question that we knew we had to answer in a clear and convincing manner when the Nuffield Trust and The King's Fund were asked by the Department of Health to contribute to the development of its strategy on integrated care. 

    Our report of this work: Integrated care for patients and populations: Improving outcomes by working together, has now been published.

    We are all too aware of the fact that 'integrated care' and 'integration' can sound rather dry and hollow as concepts, leaving most people puzzled that care could ever be...

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  8. A nicer challenge for 2012?

    16 Dec 2011
    Comments: 1

    OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

    Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

    Alan brings together his long experience of analysis in the US, and his...

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  9. Person-based Resource Allocation: a clinician's perspective

    (Guest blogger)
    16 Dec 2011

    I have to confess that it was with some trepidation that I stepped into the Nuffield Trust one November morning to hear first-hand of the progress on Person-based Resource Allocations (PBRA), designed to allocate about one third of the total budget that will be available to clinical commissioning groups (CCGs).

    The thought of trying to keep pace with Martin Bardsley’s technical wizardry around such a key issue was always likely to move me out of my comfort zone in the familiar thought patterns embedded in my basal ganglia and deliver a...

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  10. Time for a fresh approach to commissioning

    (Guest blogger)
    15 Dec 2011

    Many commentators within and without the NHS identify an under achievement of NHS commissioning. Commissioning, much like the practice of medicine, will be at its best when it conjoins art and science.

    Good management has always combined both those key attributes so why generally has it been so lacking in the practice of commissioning? What has created an NHS focus on commissioning which is predominantly about setting contracts?  A focus on input procurement, and even within that narrow contractual approach there is a paucity of effective clinically-oriented contract review....

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  11. A virtual ward for some of the most vulnerable residents of New York

    9 Dec 2011

    Earlier this autumn, I had the opportunity to visit the Hospital2Home virtual ward project in New York. Like other virtual wards, this project aims to reduce the risk of unplanned hospital admission for people at high predicted risk of admission. 

    I was particularly interested to visit this project because it has strong partnerships with health care, social care and charitable organisations, and it cares for some of the most vulnerable people in...

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  12. Is data the new hero of the NHS story?

    30 Nov 2011
    Comments: 2

    The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.

    Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.

    The second was para 4.24 – in response to...

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  13. Risk prediction: what every CCG needs to know

    17 Nov 2011

    Keen readers of this blog will already know about the importance of risk prediction in health. As my colleague, Dr Geraint Lewis, has pointed out: “neither doctors, nurses nor case managers [are] able to predict which patients [are] at highest risk of readmission to hospital.”

    So, if the NHS is to target effectively the ever increasing rate of emergency admissions, it is clear that it needs some help from predictive risk tools.

    When the...

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  14. Let's talk business: Public health, people and money

    15 Nov 2011

    The Government’s reform of public health services (detailed in the White Paper: Healthy lives, healthy people: our strategy for public health in England) has reignited debate about the importance and future of public health in the English NHS.  Although admittedly that discussion has sometimes been drowned out by the sound and fury provoked by the wider structural reform programme.

    The key argument for retaining public health involvement in the new system...

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  15. How can the Government encourage health economies to achieve integration?

    (Guest blogger)
    10 Nov 2011
    Comments: 1

    ‘Integration, integration, integration’ may not yet be on Channel 4 at 8pm on a Wednesday night but it is right up there on the agenda of the NHS.  It’s a central theme of the Health and Social Care Bill; it’s one of the key areas for the Future Forum’s second listening exercise; and perhaps, to quote Chris Ham, “it’s an idea whose time has come.”

    Our involvement with the Nuffield Trust, participation in the listening exercise and in the newly convened ‘Integrated Care Discovery Community’ here in the northwest, has given us...

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  16. Lessons learned from Toronto's virtual ward

    8 Nov 2011

    I recently had the opportunity to visit the Toronto virtual ward as part of my Management Fellowship role working with researchers at the Nuffield Trust who are evaluating the costs and benefits of the virtual wards in Croydon, Devon and Wandsworth.

    The virtual wards work just like hospital wards, using the same staffing, systems and daily routines, except that the people being cared for stay in their own homes throughout.

    The purpose of...

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  17. Legitimising health service change: lessons from Canada?

    4 Nov 2011

    In September, Andrew Lansley accepted the Independent Reconfiguration Panel’s recommendations to proceed with changes to services at Chase Farm hospital in North London. These changes continue to be very unpopular locally, but as the Secretary of State’s statement acknowledged, these were hard choices about the safety and sustainability of services. And then he added: “This is not about money. We are not making cuts to local services.”

    Whether or not local campaigners agree, this statement...

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  18. In defence of single clinical record systems

    28 Oct 2011

    Last month, the Department of Health confirmed that it was ditching its plans for a single clinical record system for England. Instead, IT policy will be devolved to local NHS organisations. On the face of it, this new emphasis on local flexibility may sound appealing but we should not forget the potential hazards that come with fragmented IT.

    The original plan would in essence have created a single set of medical records for all patients, to which patients could grant access to clinicians working in any part of the NHS. The alternative we are now facing will be a separate, partial...

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  19. Integrated care: time to turn policy into action

    24 Oct 2011

    Integration remains a central theme in the Health and Social Care Bill, with work in progress around the country to try and make services less fragmented for patients and their carers.

    At a recent workshop exploring how integrated care might be developed at pace and scale, which marked the launch of a new Nuffield Trust and King’s Fund project to support the development of a national strategy for the promotion of integrated care, participants agreed that financial pressures have created a ‘burning platform’, and that integration could improve patient...

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  20. We need to talk about rationing

    11 Oct 2011

    I was struck by the general appetite for a more open debate about rationing and priority setting at a recent conference on priority setting in health held by the University of Birmingham’s Health Services Management Centre (HSMC) and the Nuffield Trust.

    The conference focused on the experiences of primary care trusts (PCTs) in making difficult choices. During the morning session HSMC’s Dr Suzanne Robinson introduced findings from research published by the Nuffield Trust that explored current priority-setting...

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