1. The paradox of scale and localness in commissioning

    17 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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  2. 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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  3. New century, new hospital

    30 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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  4. Improving local price setting – opportunities and challenges

    (Guest blogger)
    25 Sep 2013
    Comments: 1

    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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  5. Competition – an incentive for GPs?

    (Guest blogger)
    24 Sep 2013

    It has been very well advertised that the Health and Social Care Act 2012 places GPs more at the centre of the health care landscape. That was the explicit intention of the Government. GPs have always combined a vital clinical role with a (related) role of gate-keeper into the wider health care system.

    The Act has given them an even more prominent role by handing a large proportion of the budget for health care spending over to clinical commissioning groups (CCGs) which GPs run. The importance of GPs in how health care evolves was emphasised by the importance...

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  6. Back to the future hospitals?

    (Guest blogger)
    20 Sep 2013

    Often a crucial report crystallises existing thinking and developments. If that is the case with the Royal College of Physicians’ Future Hospital Commission’s report, patients may be able to look forward to significant improvements in hospital care.

    As a health service historian I am fascinated by the ‘big ideas’ that colour thinking about our health service system. The first is that of the ‘system’ itself, the way in which over 200 years hospitals have progressively given up rugged independence to act as...

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  7. Personal health budgets: potential and challenges

    (Guest blogger)
    28 Aug 2013
    Comments: 3

    Starting in April 2014 the 56,000 people eligible for NHS continuing health care will be offered a personal health budget. Positive results from an independent evaluation of a three-year pilot programme provided sufficient evidence to take the approach forward.

    However, while the pilot programme has generated a lot of knowledge about how best to implement personal health budgets, important questions about how they can be sustained in the wider NHS are raised by next year’s roll out. These will need careful consideration as the roll...

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  8. Refining the case finding model

    27 Aug 2013

    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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  9. A new start for the Care Quality Commission?

    12 Aug 2013

    Today we publish our response to the Care Quality Commission’s (CQC) consultation on changes to the way it inspects, regulates and monitors care services: A New Start.

    Our response builds on the findings from our review of provider ratings, commissioned by the Secretary of State for Health, as well as drawing on the expertise of various members of our team with a past in regulation.

    ...

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  10. Can telephone health coaching prevent hospital admission?

    7 Aug 2013
    Comments: 1

    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. The wisdom of the crowd: summer reading for Whitehall villagers

    1 Aug 2013
    Comments: 1

    It is clear that Jeremy Hunt does not want to take on the role of Secretary of State for Health as envisaged by Andrew Lansley, and as designed in the Health and Social Care Act 2012.

    Confined to public health, focused on health outcomes, and at arm’s length from the NHS through the annual mandate – this was never going to work under normal circumstances, never mind when an election is looming and with the budget settlement for the NHS as it is.

    The Secretary of State will want to direct and...

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

    (Guest blogger)
    29 Jul 2013
    Comments: 1

    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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  13. NHS @ 65: transparency is the future of the people’s NHS

    (Guest blogger)
    26 Jul 2013

    You attend a hospital with your disabled daughter. You do this pretty much every day because your daughter has regular seizures and emergencies. Every time, you have to start all over again because the hospital doesn’t know who your daughter is. More paperwork.

    Then you wait and wait because the staff have to find a hoist to lift your child out of her wheelchair onto a bed. Why couldn’t you have called in advance to tell them she was coming? Hours and hours of waiting.

    This is the NHS in the experience of one mother I met recently: everyday indignities and inhumanities and, in...

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  14. CCGs: the current view from local GPs

    22 Jul 2013
    Comments: 3

    Much has been written about the current pressures facing primary care. Perhaps it seems fairly predictable therefore, to hear that many GPs are finding it difficult to engage with the clinical commissioning opportunity.

    But unfortunately for CCG leaders working hard to increase involvement, it is the support and involvement from members that provides one of their greatest potential assets.

    So how big do GPs think the challenge is ahead? New research, along with a growing body of evidence, may provide a few tips.

    ...

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  15. Back to first principles: primary care for the future

    18 Jul 2013

    Looking back over recent blogs about primary care written by Jonathan Tomlinson, Clare Gerada, John Macaskill-Smith and Helen Parker, three things stand out.

    First, there is consensus that general practice is under significant pressure, struggling to meet demand from patients, blamed for contributing to the alleged crisis in accident and emergency care, and exhorted to reassume responsibility for out-of-hours patient care.

    Second, the ‘special sauce’ of general practice – the relationship between a patient and their family...

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

    (Guest blogger)
    12 Jul 2013
    Comments: 1

    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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  17. Competition is not the way to improve general practice

    (Guest blogger)
    10 Jul 2013

    I have lived and worked as a GP in densely populated urban areas for the last 12 years and so I read with interest and dismay, Neil Bacon’s enthusiasm for the findings of the Competition and Cooperation Panel’s so-called: Empirical analysis of the effects of GP competition.

    This showed that GPs with neighbouring practices less than 500 metres away made fewer referrals for certain conditions and had patients who were 0.1 per cent more satisfied than patients from...

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  18. NHS @ 65: the need for investment in general practice

    (Guest blogger)
    8 Jul 2013

    The NHS is struggling and general practice is one area bearing the brunt of the pressure to meet increasing, and changing, patient needs.

    We have a growing and ageing population in the UK. From a GP’s point of view, we are seeing more patients than ever before, making up to 70 patient contacts a day, which previously would have only been seen in exceptional circumstances, such as a flu pandemic.

    And these patients are often presenting with complex, chronic and multiple conditions, both physical and mental.

    Additionally, another round of...

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  19. NHS @ 65: tender, fragile, fragmented, strained, vulnerable

    (Guest blogger)
    4 Jul 2013

    Tender, fragile, fragmented, strained, vulnerable. In disarray. At a cross-roads. These are just some of the words used by key contributors to the Nuffield Trust’s latest publication: The wisdom of the crowd: 65 views of the NHS at 65.

    The service has never been particularly good at celebrating its big anniversaries. The tenth, in 1958, was pretty much all sweetness and light. But most of the others – from the 20th through to the 50th – were overshadowed by one crisis or another, by a sense of foreboding, or by both.

    By contrast, the 60th, back...

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  20. NHS @ 65: views of patients must be heard

    3 Jul 2013

    It appears that the founding principles and aspirations of the NHS remain largely intact, but they are under great and increasing strain. This relates in part – but only in part – to increasing demands and costs brought about by demographic change, high expectations and new therapeutic opportunities offered by technological advance.

    But these factors are not the sole cause, nor in the views of patients, public and staff are they the most important.

    As the Francis Inquiry – the latest of several into shameful events – has so painfully shown, unless...

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