1. Evaluation: rigour, relevance and naivety

    (Guest blogger)
    29 Jun 2015
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    Professor Martin Marshall and Laura Eyre from UCL explore the challenging questions often asked of evaluation experts. 

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  2. Don’t look back in anger – retrospective matching when an RCT won’t do

    15 Jun 2015
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    Evaluation is on everyone’s lips these days as the plethora of new and existing initiatives, such as Integrated Care Pilots, the Better Care Fund and most recently the Vanguard sites are under scrutiny to show that these new models are actually delivering on their promise. Like the attendees coming to our Evaluation of complex care 2015 conference you may well be grappling with the question of whether a Randomised Controlled Trial (RCT) is a possible way to evaluate the complex, community based...

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  3. Getting the most from evaluation

    31 Mar 2015
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    How can we get the most out of evaluation in health? Dr Alisha Davies explores. 

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  4. The ‘wicked’ problem of access: is the telephone a solution?

    6 Aug 2014
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    This week a study in the Lancet concluded that phone consultations with patients who request same-day appointments generate additional work for GPs when compared to face–to-face encounters. In some ways, the study provides further evidence for the existence of induced demand – the phenomenon that widening access for health care fuels use – that we highlighted in a recent Nuffield Trust report (June 2014).

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  5. A risk worth taking?

    24 Jul 2014
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    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.

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

    (Guest blogger)
    2 Jun 2014
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    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.

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

    (Guest blogger)
    7 Apr 2014
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    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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  8. Informing the public on information

    17 Jan 2014
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    Most of the services we receive nowadays (be it internet shopping, high street banking or health care) have a trail of data associated with them. We’ve come to expect that these trails will be used to help future interactions be more efficient for us and/or those providing the service.

    This applies as much to public as private sector services – though we’ve also come to expect that the public sector lags well behind the private sector when it comes to IT matters.

    In many cases this perception of the public sector is probably true (any luck making a GP appointment online...

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

    6 Nov 2013
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    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 telehealth reduce demand on GPs?

    28 Oct 2013
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    After several years in gestation, the Whole Systems Demonstrator (WSD) trial of telehealth is now producing a steady stream of outputs – most recently in the form of a paper looking at whether telehealth changed the frequency with which people used GPs and practice nurses.

    The WSD, one of the largest trials of its type in the world, focussed on one use of telehealth as a form of remote monitoring and support to help people better manage their chronic health conditions – which in this study meant either...

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  11. Time for QualityWatch

    9 Oct 2013
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    The quality of NHS care has been scrutinised in the past year probably more than in any other since its birth. We are contributing to this debate by launching QualityWatch – a programme to look at how quality of care in England is changing.

    The past two years have seen a series of reports detailing high-profile failures of care or concerns about other potential ones. It is clear that assessing quality is of increasing importance to an increasing number of organisations, both...

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  12. Improving local price setting – opportunities and challenges

    (Guest blogger)
    25 Sep 2013
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    Approximately £40billion of total NHS expenditure in 2011/12 was spent on local contracts for services that do not have nationally mandated prices. Until now little research has been done to assess just how effective these have been in delivering more for patients, with the focus being on national price setting.

    Recent Monitor research highlights that pressure on local commissioners to balance annual budgets may limit their potential to drive better quality care for patients through local contracts for...

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  13. Refining the case finding model

    27 Aug 2013
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    The Nuffield Trust has just published a paper on a new predictive model. We hope that the paper and the accompanying details can help both commissioners and providers of care refine the ways that they use risk stratification and case finding tools.

    The market for predictive modelling tools has grown a lot in the last few years. Alongside the old familiars, such as Patients At Risk of Re-hospitalisation (PARR) and the...

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  14. Can telephone health coaching prevent hospital admission?

    7 Aug 2013
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    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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  15. 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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  16. Community-based interventions: how do we know what works?

    26 Jun 2013
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    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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  17. Would we know it if we saw it?

    30 May 2013
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    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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  18. Bet the farm on information over competition

    30 Apr 2013
    Comments

    Odd isn't it that after ten years of policies to encourage competition and choice and ten years of an increasing share of NHS cash spent on non-NHS providers, the evidence base supporting the benefits of competition in health care is too thin to make a sound judgement.

    Odd, until you think of the evidence base to support integrated care, which is equally thin.

    No wonder there is such room for howls of protest and undisciplined debate which doesn't get us much further forward. No wonder existing regulations and...

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

    17 Apr 2013
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    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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  20. Should there be 'Ofsted-style' ratings for health and social care providers?

    22 Mar 2013
    Comments

    This was the question set by the Secretary of State.

    We’ve been there before, and the added value of previous ratings relative to the costs is not clear either way. Nor indeed is the potential for ratings to have an impact in the future if there were improvements in its design and use.

    So what might ratings add today? There are two obvious gaps.

    First, there is currently no independent comprehensive assessment of quality across all providers and across the full spectrum of performance. Second, there is nothing...

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