1. Festive cheer? Alcohol and the NHS

    18 Dec 2014
    Comments

    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.

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

    (Guest blogger)
    30 Oct 2014
    Comments

    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'.

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  3. Improving cancer diagnosis: is there a better way than naming and shaming?

    30 Jul 2014
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    In a drive to improve England’s record on cancer survival, Jeremy Hunt recently announced that he will 'name and shame' low-referring GPs. It’s clear that improving early diagnosis of cancer could improve survival. But it’s not clear how shaming GPs into referring more patients will solve the problem of delayed diagnosis.

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

    8 May 2014
    Comments

    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.

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

    (Guest blogger)
    7 Apr 2014
    Comments

    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.

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  6. Come again? What the data tells us about repeat A&E visits

    9 Jan 2014
    Comments

    The BBC’s research, published yesterday, on frequent users of A&E makes for interesting reading. They found that nearly 12,000 people made more than 10 visits to the same unit in 2012/13, and a small number of those attended more than 50 times. This is an eye catching finding and it is important to consider what those numbers might actually mean.

    While the 200,000 attendances used by people attending A&E more than 10 times a year is a big number, it represents just a tiny fraction of the 14 million total attendances at...

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  7. The quality of care: we must keep watching

    21 Nov 2013
    Comments

    This week the Care Quality Commission (CQC) have published their annual report on the state of care. It provides a useful overview of the state of care services in England, and also tells us a little of the state of the regulator too.

    Everyone understands that these are difficult times for care services. The financial constraints introduced in 2010/11 are starting to bite and the NHS is still coming to terms with its recent re-organisation. Many people are worried about the impact this may be having on...

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  8. Houston, we have a problem

    12 Nov 2013
    Comments

    Next year (2014/15) is an important year – if all had gone to plan the structural current deficit would be eliminated and it would be the last year of austerity. It was also supposed to be the year in which almost all NHS trusts became foundation trusts (FT).

    As it is, the Government is not expecting to close the current account deficit until 2017 and 100 NHS trusts are still not foundation trusts.

    The combination of deteriorating finances and the new Care Quality Commission (CQC) inspection regime mean that very few will make it to FT status this side of the election.

    ...

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  9. Virtual reality: observations from the Nuffield Trust study of Virtual Wards

    6 Nov 2013
    Comments

    Implementing new models of care is not easy – and especially so when organising community-based services that aim to tackle the challenges of more chronic disease and greater levels of emergency care.  

    One of the more interesting approaches of the past few years has been the Virtual Ward and we recently published a report, funded by the National Institute for Health Research Service Delivery and Organisation Programme, looking at three early examples of Virtual...

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  10. Can telephone health coaching prevent hospital admission?

    7 Aug 2013
    Comments

    Health services around the world are attempting to improve care for people with long-term conditions, as currently it is often fragmented and expensive. Many interventions have been tried and tested. To the long list of evaluations another can now be added – that of Birmingham OwnHealth (published today in the BMJ).

    Birmingham OwnHealth was England’s largest example of telephone health coaching, established in 2006. Operating as part of...

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  11. Predictive risk: an idea whose time has come?

    (Guest blogger)
    29 Jul 2013
    Comments

    The Nuffield Trust recently held its fourth annual conference on predictive risk - or applying statistical models to populations in order to identify patients who might benefit from health interventions of various kinds.

    The mere fact that this was the fourth conference on the subject shows that this is an idea with legs. And, indeed, it has just been given a boost by the Department of Health, which has included a directed enhanced service for ‘risk profiling and care management...

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  12. NHS @ 65: the NHS cannot do it alone

    (Guest blogger)
    12 Jul 2013
    Comments

    We are in danger of losing our collective nerve over the future of the NHS. In 1948, in the midst of austerity and post-war national exhaustion, Britain created a comprehensive health service which offered care to those who needed it regardless of their means.

    It was a courageous idea whose time had come and it made compelling economic, political and social sense. It still does.

    In 2013 our far richer country can and should continue to embrace Aneurin Bevan’s vision. Of course we face very different...

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  13. Community-based interventions: how do we know what works?

    26 Jun 2013
    Comments

    Over the past four years the Nuffield Trust have been asked to look at a range of service innovations and assess whether they lead to a change in service use – most typically a reduction in inpatient hospital activity, which is something that seems to have become the holy grail of health service planning.

    Our new report summarises observations from our studies and efforts that might help those planning and evaluating new services in the future. In particular, the report should provide useful learning for the new...

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  14. The challenges facing our hospitals – doing what needs to be done

    (Guest blogger)
    20 Jun 2013
    Comments

    The litany of challenges facing hospitals is by now familiar: rising demand, spending restraint, making the best use of new technologies, and finding ways to adjust the acute sector to a world of chronic illness.

    A service that has struggled to make progress on productivity for decades now faces a future in which there will be no alternative but to make steady efficiency improvements, year on year, while at the same time maintaining a level of quality upon which vulnerable people depend.

    The task is daunting, but I remain an...

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  15. Long-term care reform in the United States

    (Guest blogger)
    19 Jun 2013
    Comments

    Long-term services and support (LTSS) primarily refers to personal care services that include home help, care in nursing homes and assisted living, as well as day care.

    Of the 13 million Americans that need long-term care, only 13 per cent have received help in paying for these services. The situation is set to become even more challenging, as the proportion of Americans over the age of 65 is...

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  16. Would we know it if we saw it?

    30 May 2013
    Comments

    A week after the Government's integrated care pioneer programme kicked off, the evaluation of North West London's integrated care pilot was published. The ingredients of the pilot were sensible, for example: investment in IT, risk stratification and targeting of high risk patients, leadership, coordination of multidisciplinary groups, and project management.

    The results so far: high commitment by professionals; greater collaborative working across teams and with social...

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  17. The 'new' NHS and the emergency care challenge

    (Guest blogger)
    19 Apr 2013
    Comments

    This is a critical time for the NHS, with many key themes to discuss. But my start to the year is dominated by emergency care – a very practical challenge but one that raises important questions about culture too.

    Across the NHS we are really struggling with emergency activity. Even allowing for Norovirus and prolonged cold weather we are experiencing unusual pressure.

    The...

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  18. The NHS in numbers: performance in the boom years

    17 Apr 2013
    Comments

    Our new series of interactive charts: The NHS in numbers pulls together some key data on health care spending, activity, resources and performance. These charts broadly cover the boom years for health care in the UK, from the late 1990s to the early 2010s, reflecting the latest data publicly available from official sources.

    During this period, when Government spending on the NHS rose at the fastest rate experienced throughout its history, both public and private spending on health care increased year-...

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  19. Mergers, 24/7 working and ratings – mind the gaps

    30 Jan 2013
    Comments

    The queasily thin amount of experienced medical cover in some hospitals at nights and weekends was the subject of BBC Radio 4's File on 4 last week. Juniors missing key symptoms and signs, not wanting to bother a consultant out of hours, with occasional tragic results or at best near misses.

    Suggestions for remedy included making consultants work 24/7 rotas. I sympathised with the experienced paediatrician who predicted that would be the last straw for many who have given their all for the NHS over many years.

    The...

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  20. Just how good have we been at preventing emergency admissions?

    11 Jan 2013
    Comments

    It's not as if we are not trying to reduce our need for emergency care. The past decade has seen a host of initiatives, innovations, policies and practices that should be helping to avoid the sort of health crises that lead to an emergency admission to hospital.

    But have these worked? A recently published paper by the Nuffield Trust used a standard measure of health service performance to see what changes had occurred over the past decade.

    The analysis looked at emergency hospital admissions for conditions where...

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