1. 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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  2. A patient perspective on self-care

    (Guest blogger)
    25 Feb 2015
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    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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  3. 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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  4. 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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  5. MPs will always be part of the rationing equation

    (Guest blogger)
    18 Feb 2015
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    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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  6. Rationing: An unhelpful term for the broader issue of prioritisation

    (Guest blogger)
    18 Feb 2015
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    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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  7. Fact or Fiction? Targets improve quality in the NHS

    13 Feb 2015
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    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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  8. Mortality rates: getting the right measure

    13 Feb 2015
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    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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  9. Managing doctors, doctors managing: Troubled relations at the heart of the NHS

    (Guest blogger)
    6 Feb 2015
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    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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  10. Fact or Fiction? The Welsh NHS performs poorly compared to the English NHS

    5 Feb 2015
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    This blog is the second 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.

    Despite being a devolved issue whose political fate will not be next determined until Welsh Assembly elections in 2016, the NHS in Wales has become a key battleground in the UK general election.

    Claims about the Welsh NHS fly back and forth between politicians in Westminster and Cardiff Bay: Labour politicians can barely appear on...

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  11. 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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  12. The challenge of change in the NHS in Wales

    30 Jan 2015
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    [Editor's note: This analysis first appeared on BBC News Wales.]

    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...

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

    29 Jan 2015
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    This blog is the first 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.

    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...

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  14. 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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  15. 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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  16. 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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  17. 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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  18. 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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  19. 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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  20. 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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