1. 2014: A one year backward look

    19 Dec 2014

    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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  2. Festive cheer? Alcohol and the NHS

    18 Dec 2014

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

    17 Dec 2014

    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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  4. Prevention is better than a cure

    15 Dec 2014
    Comments: 2

    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


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

    11 Dec 2014

    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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  6. How pharmacy could save the NHS

    (Guest blogger)
    9 Dec 2014

    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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  7. Volunteering in the season of goodwill

    8 Dec 2014
    Comments: 1

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

    5 Dec 2014

    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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  9. An army of the willing?

    3 Dec 2014

    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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  10. A borderline debate

    24 Nov 2014

    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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  11. The population time-bomb: can NHS spending keep pace?

    19 Nov 2014

    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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  12. General practice: too tired to change?

    (Guest blogger)
    13 Nov 2014
    Comments: 1

    The unrecognised – and under-celebrated – core of our successful NHS has been the role of general practice. Their registered list of patients has enabled continuity of care, continuity of patients’ records and long-term relationships that build mutual trust. Fortunately, NHS England’s Five Year Forward View has recognised this, with calls for further investments in general practice, as well as more integrated care.

    A modern, forward looking, sustainable and thriving...

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  13. Is general practice really in crisis? Moving beyond the headlines

    (Guest blogger)
    4 Nov 2014

    A sample of headlines about general practice over any seven day period for the last six months would likely describe a service either on the brink of – or already engulfed within – a serious and potentially intractable crisis. 

    The falling investment in primary care has led some commentators to predict in the region of 500 doctors’ surgeries going out of business. 

    Others highlight the demographic split of the GP workforce – with a disproportionate number within five years of viable retirement – and...

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  14. Three key factors for making NHS England’s Forward View a success on the frontline

    31 Oct 2014

    In my clinic last Friday I was shocked: four out of sixteen appointments were taken by patients who were unable to gain access to the hospital services they had been told they needed. Having each tried to contact the hospital several times, they came to me to ask for help in navigating hospital booking systems, for interim pain relief, and reassurance. GP appointments that should have been available for clinical problems were used for administrative support, alongside clinical advice on the symptoms that arose from delays in care.

    ... Continue reading
  15. Over-stretched hospitals: let's improve how patients are met on arrival, not block the front door.

    (Guest blogger)
    30 Oct 2014

    Jeremy Hunt this morning pledged that £5bn worth of Better Care Fund allocations, founded on targets for reducing urgent hospital admissions, will 'change the basic NHS model'.

    Likewise, this year we have had Clinical Commissioning Groups making projections for rapid...

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  16. Local leaders and MPs must embrace NHS England vision

    23 Oct 2014
    Comments: 1

    It’s the report the NHS has been waiting for. 

    Simon Stevens’ vision for the future of how care will be organised and delivered in England is set out in the Five Year Forward View – the first time the arm’s length bodies in the NHS have come together to produce such a report. 

    Just as he did when creating The...

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  17. Is a transformation fund really the answer for the NHS?

    20 Oct 2014

    A number of organisations have been arguing that there needs to be a transformation fund to support change in the NHS.  

    What they are picking up is something that is very noticeable when comparing the NHS to other sectors and to health systems in many other countries – the absence of a banking function or mechanisms to support organisations while they restructure. This is how the asylums were closed and community mental health services developed.  

    Fixing this is important. The process of change is long, often uncertain and will mean that some organisations running...

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  18. Party conference commitments on NHS spending: the unanswered questions

    15 Oct 2014
    Comments: 2

    I am writing this from my hospital isolation room having just had a stem cell transplant that will I hope cure my dysfunctional bone marrow. The transplant and the care that goes with it is a tremendous fusion of compassion, research, pharmaceutical development, attention to detail, dedicated caring professionalism from the unit director through to the receptionists, significant voluntary sector input largely from the Anthony Nolan Trust but also in funding of hospital facilities, and international cooperation.

    There is no suitable donor for me on the UK registry. But the much larger...

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  19. Those worrying about the transatlantic trade deal should look closer to home

    6 Oct 2014
    Comments: 1

    There has been a lot of concern expressed about the planned free trade deal between the European Union and the US, the Transatlantic Trade and Investment Partnership, and the impact it will have on the NHS.

    TTIP seems to combine a number of popular demons in health circles: privatisation, US healthcare, competition and Europe. The fact that the Department for Business, Innovation and Skills is leading UK negotiations on behalf of the NHS might also make those who remember the Working Time Directive nervous.

    So just how big a threat is TTIP to the way the NHS works? The...

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  20. Could health and wellbeing boards really work as a single commissioner?

    3 Oct 2014
    Comments: 2

    When Health and Wellbeing Boards (HWBs) were introduced in local authorities (LAs) in 2012, their original purpose was to improve the health and wellbeing of local communities and reduce inequalities by promoting integration across health, care and other services.

    While this original job description for HWBs did not include a commissioning role, the idea of HWBs as a facilitator of better joined-up commissioning across NHS services, social care and health improvement is rapidly gaining currency. 


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