1. A risk worth taking?

    24 Jul 2014
    Comments: 1

    The concept of predictive risk, or using linked person-level data to identify the patients most likely to have future unplanned hospital admissions, is now firmly embedded in the NHS. Here at the Nuffield Trust we recently held our fifth annual conference on the topic.

    One of the joys of holding an annual event on the same subject is that it provides an opportunity to see how things change from year to year, and it is certainly true that the world of risk stratification has come a long way over the past few...

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  2. The Better Care Fund: no easy way out

    16 Jul 2014

    Nokia CEO Stephen Elop found a place in the vocabulary of austerity-beset civil servants everywhere when he told his struggling company’s staff they stood on a “burning platform”. The phrase suggests that, like a man jumping from a blazing oil rig, managers and organisations can expand the range of what they see as possible if times get tough enough.

    The Better Care Fund was designed to be the quintessential “burning platform” policy. Into this pot of funding, in 2015/16, will go £1.9 billion top-sliced from the budget of NHS commissioners, £1.1 billion of transferred money for local...

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  3. Only half the picture: understanding the impact of the social care squeeze

    11 Jul 2014

    Yesterday our Into the Red? report revealed worrying signs about the future funding of the NHS in England. This was echoed in the results of our first survey of leading figures from the field of health and social care, with around half of respondents saying they felt it was unlikely that the NHS would be free at the point of use in ten years’ time.

    But the NHS is only half the picture....

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  4. Financial Crystal Ball Gazing

    10 Jul 2014

    Our report, Into the red? The State of the NHS’ finances, sets out the facts on NHS expenditure between 2010 and 2014. It is clear on figures for 2013/14 from Monitor and The NHS Trust Development Authority, that, subject to audit, NHS providers will post a small overall deficit of £100 million. Equivalent figures from NHS England show that the commissioning side will produce a small surplus. The overall result for the entire NHS is likely to be happiness in Mr Micawber’s terms....

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  5. We won! The World Cup of health care systems

    27 Jun 2014
    Comments: 3

    According to the Commonwealth Fund’s latest report “Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally” which compares 11 industrialised countries, the UK has won the ‘World Cup’ of health care systems.

    It was a close thing with Switzerland and Sweden – but we managed. Sadly, the United States lost. After the events in Brazil, we should really be celebrating the success of our NHS. Especially, as we spend so little on the ‘NHS team’ compared to the US. But if it only was that simple, we...

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  6. The benefits to patients? Shining a light on the NHS merger regime

    (Guest blogger)
    24 Jun 2014

    Last week was a landmark: a new competition authority (the Competition and Markets Authority (CMA) – itself the consequence of a merger) approved the first full merger of two NHS acute trusts. Their decision will allow the merger between Frimley Park Hospital NHS Foundation Trust and Heatherwood and Wexham Park Hospitals NHS Foundation Trust to proceed.

    The competition authorities are quick to point out that this is the third NHS merger they have approved since the passage...

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  7. Making hospitals fit for the frail older people who actually use them

    (Guest blogger)
    19 Jun 2014

    On June 9, I finished my ward round of 24 inpatients – median age 80-plus, legged it to the station and got into London just in time to set up my workshop on models of care for frail older people at the Nuffield Trust Future Hospitals conference.

    At the event, I presented some challenging ‘home truths’ alongside an animation and some practical solutions.

    The “home truths”

    Sometimes, people who feel they are challenging orthodoxies end up becoming the...

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  8. The £billion question: funding the Welsh NHS for the future

    17 Jun 2014
    Comments: 2

    If the next two years look tough for NHS Wales finances, the long-term could be dire – and not just for the health service.

    The NHS in Wales has become a catspaw in Westminster knock-about, but the Nuffield Trust study: A decade of austerity for Wales? reveals a much deeper question about the long-term financial sustainability of the NHS, echoing the debate which is already gathering pace in England.

    Unless resolved, the choice between funding health pressures and funding all other public services in...

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  9. The future of the hospital: some useful lessons

    13 Jun 2014
    Comments: 4

    NHS England Chief Executive Simon Stevens issued his challenge to rethink the role of the hospital in more imaginative ways after this week’s Nuffield Trust’s conference on the future of the hospital was already in the diary.

    There were some clear lessons from our audience of hospital leaders – many on the theme that simple answers of hot-cold splits (separating emergency from elective care), centralisation, mergers etc are not working. I took away a number of lessons:

    Decisions need to be made about where to focus: smaller hospitals...

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  10. Local leaders unleashed? What to expect from Simon Stevens’ reign

    4 Jun 2014

    The response to NHS England Chief Executive Simon Stevens’ first interview says as much about the challenges facing the NHS as the content of the interviews themselves.

    Mr Stevens’ message – to be pragmatic, to decide what’s right locally, to be bold, and to look beyond current bricks-and-mortar configurations – quickly transmuted under the media spotlight into one of harking back to a bygone age of cottage hospitals.


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  11. General practice needs more than money

    3 Jun 2014
    Comments: 2

    It seems that hardly a week goes by without another report of workload pressure, lack of funding and general imminent doom in general practice. As a response to this, the Royal College of General Practitioners (RCGP) has its Put Patients First: Back General Practice campaign, and the British Medical Association have Your GP Cares. Both focus on the need for more money to ease the pressures faced by GPs and their teams.

    The problem, and...

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  12. Social care and cancer: tracking care across service boundaries

    (Guest blogger)
    2 Jun 2014

    A recently published Nuffield trust report offers a fascinating insight into the routes that cancer patients take through the care system. In an era that promotes integrated care we all accept that caring for a person extends beyond one organisation; and treatment for cancer may include primary, community and social care on top of acute hospital activities.

    However, it is notoriously difficult to see what services patients are using as our information systems are usually so disjointed. Yet as this report shows it is now possible to...

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  13. NHS and social care funding: speaking truth to piety

    30 May 2014
    Comments: 3

    As the noise generated by last week’s local and European elections fades, political energy will now be directed towards defining the policy battlegrounds on which next year’s General Election will be fought, which will have to be much wider than immigration and the European Union.

    Even though the NHS is so central to politics in the United Kingdom, predicting how noisy an issue it will be in the run up to next year’s General Election is difficult. This is partly because of its peculiar status, at least in the minds of politicians, who believe that the voting public has an essentially...

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  14. The Better Care Fund: do the sums add up?

    8 May 2014

    Yesterday's Guardian reports that the Government’s plans for the Better Care Fund have been put on hold as the Cabinet Office demand that the Department of Health do more to explain how the savings needed to pay for it will be secured. Government sources have been quick to dampen speculation that this signals trouble for the plans.

    But the question reportedly asked by the Cabinet Office is exactly the right one, albeit at an odd time, as the Bill to set up the Fund is...

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  15. Primary care: will Stevens drop the 'cookie cutter'?

    30 Apr 2014
    Comments: 2

    Simon Stevens’ first appearance in front of the Health Select Committee has produced some interesting changes in tone.

    He is less inclined to see competition as a barrier to change than his predecessor, hinting at a more pragmatic approach to how it is used.

    He struck a note of realism about how far we can expect the Better Care Fund to reduce emergency admissions. And he seems to have a more nuanced view about hospital reconfiguration than we have heard so...

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  16. The nitty gritty detail of integrating complex systems

    17 Apr 2014
    Comments: 1

    Recently, on one of my clinical general practice days, I made 21 phone calls to a London hospital trying to leave a message asking a consultant to call me urgently. A patient I had seen at 9am had decided not to have a disfiguring operation for a cancer that was planned for 10 days later.

    I needed urgent advice about the options for reconstructive surgery so that I could have an informed discussion with her during the following week about the choice she had made. Had she understood the facts about her condition? The consequences of refusing treatment? Time was of the essence: I...

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  17. Beyond the politics: the truth behind the UK health systems

    11 Apr 2014

    Criticism of the Welsh NHS is a popular sport for English ministers. David Cameron takes regular pot shots at longer waiting times and failure to hit A&E targets.

    To the politically cynical, it looks like a straightforward attempt to brand Labour, who governs in Wales, as a party that cannot manage the NHS.

    It may also be an attempt to show that the ‘English’ approach to managing the NHS, with the development of a market, competition and a variety of private, voluntary and other providers, is producing better results than that in Wales which abolished...

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  18. I have to readmit – it’s getting better

    (Guest blogger)
    7 Apr 2014

    Hospital readmissions for emergency care have been the subject of policy attention for a few years. The common view is that they are preventable by a better standard of care; however the reality is much more complex.

    Our research, published in the Emergency Medicine Journal, throws some light on this reality.

    We looked at 83 million hospital admissions in England using data sets spanning all NHS hospitals over a 10 year period. The team looked at patterns of readmission within 30 days, at an individual level. These large data sets make it...

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  19. Houston we need a solution: time to stop describing the problem

    3 Apr 2014
    Comments: 1

    My start at the Nuffield Trust coincides with the anniversary of the new system and Simon Stevens’ first week in charge of NHS England.

    I’ve been spending time on international work for the last two years and have been somewhat concerned by the nature of the debate on health and social care recently.

    The first reason is that there is too little public discussion about the solutions to the financial challenges facing social care and the NHS.

    There is a shared view that 2015/16 is going to be tough. We also...

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  20. Influencing GPs and the expanding role of Clinical Commissioning Groups

    1 Apr 2014

    Since clinical commissioning groups (CCGs) moved into the driving seat of the commissioning system 12 months ago, the breadth of the job they are expected to do has become apparent.

    Responsibility for each of the big changes we are increasingly told that the NHS needs – better joint working with social care, further efficiency savings in hospitals, and radical change in the scale and scope of general practice – rests largely on the shoulders of CCG leaders as the key drivers of change.

    It is the last point – the involvement of...

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