Nuffield Trust Blog

The Government spends some £140 billion a year on services for older people. The bulk of this pays for pensions and other welfare benefits, and NHS care. Just six per cent goes towards meeting the social care needs of older people.

If you were starting with a blank sheet of paper, would this look like the best balance of spending to ensure quality of life, dignity and respect in older age? Is spending so little on social care relative to health and cash payments meeting the needs of older people?

Is it the most efficient use of taxpayers’ money when we know that restricting...

Is it possible to have strong general practice (GP) ownership of a primary health care organisation, whilst pursuing a population health agenda? Geoff Meads termed this age-old tension between general practice and public health the attempt to mix oil and water.

In mineral-rich but water-poor Australia recently, I had a strong sense of déjà-vu about the general practice-public health tension.

Australia is setting up a national network of 'Medicare Locals' as part of wider health reforms. These new organisations will be responsible for planning more integrated, local primary and...

With the multiple challenges of tightening NHS finances, an ageing population and the growing burden of chronic illnesses, integrated care is seen by some as a key tool for improving the efficiency and effectiveness of care.

Many people (including people at Nuffield Trust) argue that integration can lead to both better outcomes and experiences for those who use services. In 2008 the Department of Health sought applications from sites that were interested in developing new models of clinically-led integrated care.

16 sites were eventually selected as pilots for the integrated...

Within the research group of the Nuffield Trust we have a number of studies that use the anonymised linkage of health and social care records. The results of one study are due to be published in the Journal of Health Services Research and Policy (JHSRP) soon but they have left us with a puzzle.

We found that from a population of older people (aged 75+) in four local authority areas, 14 per cent used some form of local authority social care over a one year...

Amongst all of the health reform activities in the United States, the formation of accountable care organisations (ACOs) is considered one of the more promising for bending the health care cost curve while improving patient outcomes.

ACOs are comprised of a group of providers who are held accountable for the cost and quality of care for a defined population of patients.

Successful ACOs are expected to manage costs by aligning incentives for hospitals,...

High stakes with the Health and Social Care Bill last week. But at our Health Policy Summit 2012 we pushed aside for a minute big reform, structures, and long run consensus-dividers such as competition/choice, public/private, and command versus autonomy.

Instead, we majored on – as guest Don Berwick so thoughtfully put it – ‘contextually adaptive changes’.

A physician who was formerly chief of the Centers for Medicaid and Medicare and the Institute for Healthcare Improvement, Don was upbeat that with the right changes...

Data from countries within the Organisation for Economic Co-operation and Development (OECD) shows a roughly inverse correlation between spending on health (as a share of GDP) and mortality, and a roughly inverse correlation between growth in spending on health and improvements in mortality (the correlations hold even if the US is excluded).

These glaring facts are likely to force ever more attention on health productivity, health innovation and the adoption of models from elsewhere that can demonstrably...

As the purchaser of health services for the British population, the NHS has always had to make hard choices about who is eligible for treatment, what services to cover and what criteria patients need to meet before treatment is administered.

In recent months in particular, there have been extensive debates about who bears responsibility for making these decisions and the basis on which they should be made.

These include questions about how the duties of the Secretary of State for Health should be framed, the extent to which the NHS Commissioning Board should...

A centre-right coalition Government; an unsustainable hospital sector needing reform; an ageing population living with more chronic disease; calls for more integrated care; and a belief in the power of local clinical leadership to bring about such change. Sounds familiar? Well, up to a point.

Here in New Zealand, where Carol Black and I have been taking part in the Royal New Zealand College of General Practitioners' Quality Symposium, you have to pinch yourself, such is the commonality of much of the debate about our...