1. Informing the public on information

    17 Jan 2014
    Comments: 27

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

    9 Jan 2014
    Comments: 5

    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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  3. Defining moments of 2013, predictions for 2014

    16 Dec 2013
    Comments: 1

    What were your defining moments of 2013 for the NHS? There were several contenders, but for me there were two events that bookended the year.

    The first was the Francis Report published in February. This wasn’t for its monumental nature and vast number of recommendations but it was the moment when quality decisively displaced finance as the overriding imperative for Boards and managers.

    The consequences of this are unfurling from the...

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  4. Common challenges, common solutions: lessons from primary care in Europe

    12 Dec 2013

    The Nuffield Trust’s 2013 European Summit on primary health care brought together primary care leaders from 16 countries to discuss the common challenges facing primary care organisations across Europe.

    The key findings, published today, should make GPs in England feel encouraged. They are not alone in the pressure they experience and the need to develop new ways of working, and Europe is full of ideas and examples about how to develop and change to meet the challenges of an uncertain future.

    A cluster...

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  5. Competition: acute mergers, service reconfiguration & the role of the authorities’

    (Guest blogger)
    5 Dec 2013

    There has been a lot of controversy about the competition regime as it applies to the NHS. The recent Competition Commission decision to block the proposed merger between Bournemouth and Poole trusts continues to reverberate around the NHS.

    Acute mergers are important and will continue to occupy the competition authorities. Alongside them there is a much higher volume of changes to service provision, service...

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  6. Hard truths or home truths?

    28 Nov 2013
    Comments: 2

    It has been a very busy November for the NHS. Hospitals, general practice, community and other services have been battling to deal with the apparently incessant demand for emergency advice and care – a warning sign of how difficult it will be for the service to make it through the winter unscathed.

    How far this pressure is due to constrained funding, the effects of the recession on people’s health and access to social care, growing numbers of frail elderly...

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  7. Reforming social care – the Japanese experience

    (Guest blogger)
    27 Nov 2013
    Comments: 1

    How is the oldest population in the world – Japan – coping with the long-term health and social care needs of its population?

    That is the question that a new report published by the Nuffield Trust attempts to answer:Caring for an ageing population: points to consider from reform in Japan.

    I was one of a group who visited Japan as part of this project. In the report we describe how Japan introduced compulsory social care insurance to pay for care in older age.

    Briefly, everyone over the age...

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  8. The quality of care: we must keep watching

    21 Nov 2013

    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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  9. What does the new drugs deal mean for the NHS?

    18 Nov 2013

    The new Pharmaceutical Price Regulation Scheme (PPRS) agreement looks like a good deal for the NHS.

    Getting the budget fixed for the next five years for a sizeable chunk of spend is good news. It also matches the expected trend of spending and immediate pressures on the NHS with zero increases in the branded drugs budget in 2014 and 2015 and thereafter only a two per cent increase (i.e. more or less in line with expected inflation) in each of the remaining...

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  10. Can we afford to exclude the voluntary sector from commissioning support?

    (Guest blogger)
    13 Nov 2013

    The official 'market' for commissioning support has been described as the biggest new industry in the UK, worth an estimated £1 billion. With this amount of NHS money at stake, it is essential that this market drives excellent patient outcomes and provides value for money.

    While some clinical commissioning groups (CCGs) are developing in-house commissioning support functions, some are going to the private and voluntary sector for support and over £500 million is going to commissioning support units (CSUs).

    However, the future shape of this market is...

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  11. Houston, we have a problem

    12 Nov 2013

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

    6 Nov 2013

    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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  13. The future of pharmacy: just do it

    5 Nov 2013

    All too often in discussion of the NHS, pharmacy is seen as something of a niche concern. General practitioners, consultants, nurses and even managers loom large in parliamentary debates on the future of health care, in newspaper articles and the public mind.

    Pharmacists, meanwhile, punch well below their weight in policy and management circles despite being the third largest health care profession.

    The innovative, often inspiring services I saw as chair of the Royal Pharmaceutical Society’s...

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  14. Who shall we hold to account?

    30 Oct 2013
    Comments: 2

    In the old days at the start of this century, the Chief Executive of the NHS was the man in charge, clearly accountable for NHS success or failure at national and local level.

    True, politicians occasionally ‘interfered’, as well they might given their direct accountability to Parliament and the electorate. Some did so more than others. Alan Milburn famously filled all the executive positions from CEO to HR Director. His writ ran to the operation of a hospital morgue in Bedford.

    This may not have been the best way to run the service – it certainly had its limitations and faults...

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  15. Can telehealth reduce demand on GPs?

    28 Oct 2013
    Comments: 2

    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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  16. What has been happening to NHS productivity?

    (Guest blogger)
    23 Oct 2013
    Comments: 1

    There seems to be some confusion about what has been happening to NHS productivity over the last few years. This confusion appears to stem from three primary sources.

    First, the ‘productivity’ label can be applied quite liberally. But productivity has a narrow definition: it is simply the ratio of outputs to inputs in production.

    So, productivity is not the same as ‘value for money’ – this requires some means of attaching social or consumer value to what is produced. While productivity counts the...

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  17. The paradox of scale and localness in commissioning

    16 Oct 2013

    The Nuffield Trust report is timely. Nine clinical commissioning groups (CCGs) have already planned to end the financial year in deficit.

    More may end up in deficit as the financial pressure on the NHS mounts and the new funding allocation formula creates winners and losers.

    The report identifies the work CCGs do in relation to engaging stakeholders as being critical. Involving clinicians, patients and the public in service redesign work has become fairly routine as CCGs try to reach their...

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  18. Time for QualityWatch

    9 Oct 2013

    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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  19. New century, new hospital

    29 Sep 2013

    Since the money stopped flowing freely into the NHS, there has been a relentless focus on the hospital. Recent concerns about quality are matched by continuing concern about money.

    They come together in the increasing professional and managerial clamour for reconfiguration as the solution to quality and financial issues, targeting smaller hospitals in the way stranded explorers might look hungrily at their weakest comrade.

    The recent Royal College of...

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  20. Improving local price setting – opportunities and challenges

    (Guest blogger)
    25 Sep 2013

    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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