1. 10 top tips for managing difficult service change

    (Guest blogger)
    14 Mar 2014
    Comments

    “It constantly surprises me that my colleagues don’t recognise the power of personal leadership”.

    This is one of the quotes from a study of successful service reconfigurations. All across the economy leaders have to change services – often asking users to accept different modes of delivery for financial reasons. But across the NHS, some manage it well, whereas others effectively blow their toes off one by one with a shotgun.

    Why? One is assuming that the public and colleagues are rational, and once they realise the basis of your sensible arguments, they will go along...

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  2. Working at change: responding to the Francis Inquiry

    (Guest blogger)
    4 Mar 2014
    Comments

    MBA students in the United States are now taught about the Mid Staffordshire NHS Foundation Trust Public Inquiry as a case study of institutional behaviour when leaders lose sight of their values. Will they one day also use the Care Quality Commission (CQC), as a case study of just how fundamentally a failing institution has to change?

    I know it’s stating the obvious, but I’m still amazed at how wrong decisions about the direction of an organisation (that are often relatively quick to make) can take literally years to turn around.

    Last week the CQC...

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  3. Summit’s up: issues for the 2015 election

    26 Feb 2014
    Comments

    Just over a year to go to the next election and we are all in for a prolonged bout of campaigning. Come next March we will probably all be bored, waiting for it to be over having made up our minds. So now is the best time to get a sense of what will be coming – and our annual Health Policy Summit next week will offer some clues.

    Call me a wonk if you like, but I’m looking forward to Philip Collins reviewing the political scene and Jeremy Hunt and Andy Burnham strutting their stuff, along with further debate from Rt Hon Stephen Dorrell...

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  4. Can payment reform promote better care?

    (Guest blogger)
    20 Feb 2014
    Comments

    The NHS payment system defines the mechanisms through which NHS-funded care is paid for, and the prices paid. These mechanisms and prices are levers available to commissioners to incentivise providers to achieve health care objectives, such as better health outcomes, activity targets, greater efficiency, and reduced waiting times.

    For example, the “Payment by Results” system, through which hospitals are paid according to how much treatment they provide, was introduced to incentivise more hospital activity, at a time of long and growing...

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  5. After the Francis Inquiry: are we more aware of care quality?

    (Guest blogger)
    18 Feb 2014
    Comments

    When opening the Nuffield Trust Francis one year on conference, Rt Hon Stephen Dorrell MP described the second Francis Inquiry Report as a ‘seminal event that needed to become a transformative one’.

    The Nuffield Trust report: The Francis Report: one year on states that hospitals have taken significant heed of Francis, and have focused in many and varied ways on care quality, compassion, complaints, nursing and openness and transparency.

    ...

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  6. Openness should be in the DNA of every hospital

    (Guest blogger)
    6 Feb 2014
    Comments

    Four years ago I published a report laying bare the shocking care provided at Stafford Hospital. I heard of an elderly patient left naked in public view covered in faeces, of another who died because she not given insulin, of wards where elderly patients were not helped with food and drink, of an A&E where waiting times were fabricated.

    Staff who raised genuine concerns were not listened to or respected, and...

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  7. Is the NHS a safer place a year after the Francis Report?

    6 Feb 2014
    Comments

    Imagine that today, February 6 2014, you’ve just said goodbye to your elderly mum or dad, looking small, lost and confused in a hospital bed. They’ve been admitted after a fall at home and you’ve been told they’ll be in for a few days, and not to worry because they are in safe hands.

    But you do worry, because you remember reading all those stories about what happened in Mid Staffordshire Hospital. You worry about whether, at 2am in a darkened ward, there isn’t something similar going happen to your mum or dad, if they won’t be...

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  8. Got a problem? Call 118

    30 Jan 2014
    Comments

    The Care Bill seems to be passing through Parliament with barely a ripple. Except for Clause 118. This is the clause where the Government is taking the opportunity to ‘clarify’ the law surrounding the Trust Special Administrator’s powers to drag other trusts into the frame when considering what to do with a failing one.

    It stems from the successful judicial review over the proposed closure of Lewisham Hospital’s A&E department as part of the Special Administrator’s plans to deal with the...

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  9. Under pressure: hospital organisation in Europe

    (Guest blogger)
    29 Jan 2014
    Comments

    Hospitals across Europe are under pressure. They all tend to have business models which rely on growing income and payers that are increasingly trying to contain them.

    Big questions are being asked about future strategy but there is surprisingly little public debate about this important part of the health system and there is insufficient policy analysis.

    Our recent European Summit brought together leaders and analysts from across 16 countries to compare notes. This revealed some interesting differences...

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  10. Informing the public on information

    17 Jan 2014
    Comments

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

    9 Jan 2014
    Comments

    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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  12. Defining moments of 2013, predictions for 2014

    16 Dec 2013
    Comments

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

    12 Dec 2013
    Comments

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

    (Guest blogger)
    5 Dec 2013
    Comments

    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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  15. Hard truths or home truths?

    28 Nov 2013
    Comments

    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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  16. Reforming social care – the Japanese experience

    (Guest blogger)
    27 Nov 2013
    Comments

    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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  17. The quality of care: we must keep watching

    21 Nov 2013
    Comments

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

    18 Nov 2013
    Comments

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

    (Guest blogger)
    13 Nov 2013
    Comments

    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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  20. Houston, we have a problem

    12 Nov 2013
    Comments

    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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