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

    (Guest blogger)
    20 Jun 2013

    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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  2. Do home palliative care services have an impact on where people die?

    (Guest blogger)
    18 Jun 2013

    As in many other developed countries, the UK population is rapidly ageing. This has implications for the provision of health and social care, as older age and life-limiting, chronic conditions are closely linked. There is a growing need for palliative care.

    One of the key values of palliative care is to enable people to choose where to be cared for at the end of life. When asked for their...

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  3. Would we know it if we saw it?

    30 May 2013
    Comments: 6

    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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  4. The benefits to patients of 'healthy' competition

    (Guest blogger)
    28 May 2013
    Comments: 3

    I once worked with a consultant who had an uncanny ability to extract the truth from his junior staff. When he suspected dubious information (such as “I’m sure the patient had a high erythrocyte sedimentation rate (ESR)”) he’d say, “Is that a guess, rumour, fact or lie?”

    Of course, he did it in such an intimidating manner that the answer was clear by the blood draining from the face of the poor, unfortunate wretch who didn’t have all the information to hand.

    The current debate about the absolute need to reorganise and improve the NHS often reminds me of that consultant’s total...

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  5. Transforming general practice: GP providers thinking big

    23 May 2013

    General practice seems to be considered by politicians and the media as both the cause of and solution to the current crisis in demand for urgent and emergency care.

    At the same time, the primary care community is recognising that the current business model of general practice is under threat due to increased demand by patients, growing regulatory workload and, for some this year, significantly less income.

    From discussions with GPs and policy makers, there appears to be some consensus that the current ‘small scale’...

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  6. AQP roll out not guaranteed to lead to voluntary sector expansion

    (Guest blogger)
    22 May 2013

    Well, we know when dealing with Government that rhetoric can outrun reality. Whether it's Blair or Cameron, they are eloquent on the need for an expansion of the third sector.

    And, let's face it, given the challenges of long-term conditions and the preponderance of the elderly in hospital beds, we know a major expansion of charity and social enterprise provision is the bedrock of reform.

    The recent evidence from the Foundation Trust Network (FTN) on ...

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  7. Queen's Speech 2013: the impact of immigration on the NHS

    14 May 2013
    Comments: 3

    The impact of immigration on the NHS has long been a contentious topic and the Queen's Speech last week, which outlined plans to restrict migrants' access to NHS care, has thrust it into the headlines once again. Yet hard data on the issue have sometimes been thin on the ground.

    In 2011, the Nuffield Trust published an analysis that looked at how often international migrants to England use hospital care in comparison with English-born people.

    To our...

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  8. Demanding your attention: Caldicott's Information Governance Review

    8 May 2013
    Comments: 3

    Even its best friends will grudgingly admit that information governance is not a topic that grabs you by the lapels and demands your attention.

    That is, however, until some brave soul attempts to tweak the laws and directives around the use of data in the UK, at which point the issue suddenly becomes extremely interesting.

    The latest intervention in this area, the most important for some years, comes from an independent working party headed up by Dame Fiona Caldicott (of the original...

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  9. Bet the farm on information over competition

    30 Apr 2013

    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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  10. How primary care providers can rise to the challenges of the public health agenda

    (Guest blogger)
    25 Apr 2013

    The release today of a crucial report written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC) sets out the challenges that face primary care and general practice.

    In particular, the report looks at moving from a purely curative and reactive based approach to patient care, to one that is balanced against making significant inroads into the reduction of the rise in chronic ill health set against the backdrop of an ageing population.

    As the NHS struggles to meet unprecedented financial efficiency...

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

    (Guest blogger)
    19 Apr 2013

    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.


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

    17 Apr 2013

    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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  13. Preparing for the 'new' NHS: lessons from departing leaders

    28 Mar 2013

    Never in the field of NHS re-organisations can so many have left so few. Well, not literally. But April 1 sees some 160 NHS organisations, including all primary care trusts and strategic health authorities, abolished as hundreds more – 211 clinical commissioning groups plus a clutch of new national bodies and their regional arms – come formally into existence.

    The result is what must be an unprecedented turnover of NHS chief executives. Some retiring, some moving on to other jobs, some taking redundancy, some leaving the direct employment of the service, some willingly, some not....

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  14. The lost decade

    27 Mar 2013

    The Budget 2013 confirms that funding for health in England will be frozen in real terms for a further year – up to 2015-16 – and the requirement to under-spend allocations is here to stay. The Government has also extended the one per cent cap on pay awards for a further year and is talking about limiting pay progression.

    This is hard for NHS workers but will be a big help to NHS organisations trying to match the money with the pressures on services.

    After 2015-16 the Office for Budget Responsibility’s...

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  15. Should there be 'Ofsted-style' ratings for health and social care providers?

    22 Mar 2013
    Comments: 2

    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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  16. Reflections on the summit: a narrative for change?

    (Guest blogger)
    19 Mar 2013

    The first day of last week’s Nuffield Trust Health Policy Summit concentrated on the linked issues of quality and finance.

    It’s clear we are going to have to improve the amount of the former whilst having less of the latter.

    I will return to that issue, but throughout my time at the Summit I couldn’t get away from the idea nagging at me that here we are in the spring of 2013 and now, right now, would have been a great time to launch an NHS reform programme from the Government.


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  17. Enhancing standards – silver bullets can be expensive

    14 Mar 2013
    Comments: 1

    In a speech to the Nuffield Trust a few years ago, the then-Secretary of State for Health, Andrew Lansley, turned to the failings of care at Mid-Staffordshire to motivate his argument for reform.

    In defending the cause of clinically-led commissioning, Lansley said: ‘where were the GPs? I’ll tell you: the GPs were there, they sent the patients to the hospital’ but too often they had a culture of ‘refer and forget’.

    One of the questions asked by the Francis Inquiry has been: ‘where were the primary care...

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  18. What role can patients play in improving quality?

    (Guest blogger)
    7 Mar 2013
    Comments: 1

    Back in 2002, I learned a valuable lesson: The patient’s view is paramount.

    Building user involvement in Motor Neurone Disease was a service improvement project at King’s College Hospital that included an in-person support group, newsletter, dedicated telephone group, and an online asynchronous message board or ‘forum’.

    As the lead researcher wound down the project, the team found there were two young patients, diagnosed in their early 20s, still using the forum to communicate.

    That’s when I...

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  19. Snapshot survey on the NHS: is confidence faltering?

    6 Mar 2013

    For the third year running, we have carried out a small, snapshot survey of the NHS amongst the policy makers, senior managers, academics and clinicians who are attending our forthcoming Health Policy Summit, which takes place on 7 and 8 March.

    This survey does not pretend to be representative in any way, but nevertheless provides a flavour of opinion amongst the 53 people who responded, in the wake of a year which has brought prolonged gloom about the prospects of improvement in the state of public finances and the passing and...

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  20. NHS productivity: more of the same or more for less?

    (Guest blogger)
    5 Mar 2013
    Comments: 2

    The Francis report has pushed money well down the pecking order as quality takes first, second and third place.

    But as we come to the end of the financial year some eyes will again turn to how well the service is maintaining financial balance, meeting the Nicholson challenge of £20 billion savings and raising quality.

    We know that the NHS needs to increase productivity to make savings, raise quality and balance the books. The consensus is that NHS productivity flat-lined over much of the last...

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