Nuffield Trust Blog

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...

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...

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...

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....

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...

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...

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...

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...