Efficiency

With the showers has come a certain malaise tinged with queasy uncertainty.

This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with respect to the mass reorganisation outlined in the now Health and Social Care Act.

The queasiness extends beyond health, look at local Government for example facing an average six per cent cuts rather than a ‘flat real’ settlement as in health.

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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...

The introduction of the Health and Social Care Act 2012 was trumpeted in some quarters (including, apparently, the Cabinet room) as a hard-won victory for Andrew Lansley and his plans to ‘liberate the NHS’.

For the battalion of health service managers, however, the campaign has now begun in earnest. It is they who have to take the legislation, translate its complex clauses into practical plans, and determine how far Lansley's hopes will be realised and the fears of his detractors proven or not.

NHS...

The Chancellor made no announcements on the future of the NHS in his 2012 Budget statement. Yet, the contents of the Budget report have quite profound implications for NHS funding.

They also reveal some interesting facts about the short-term.

Short-term movements

According to the 2010 Spending Review, the Government planned to spend £105.9 billion in 2011-12 on health in England. In Budget 2012, that total is now £900 million less.

While £400...

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...

Annual per capita growth rates in acute care costs are increasing fastest for older adults.

Given that this growth rate is expected to continually increase, it is imperative that we increasingly focus our efforts around developing new cost-conscious models that are also able to meet the complex needs of older patients.

The biggest problem is that our current hospital care model was developed years ago when most adults tended to not live past 65 or were living with chronic illnesses and usually only had one active problem that brought them to hospital.

While things still...

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...

The Nuffield Trust’s fourth Health Policy Summit opens on Wednesday, bringing together senior health leaders, clinicians, policy-makers and academics. The timing is not auspicious.

The intense political wrangling over the Health and Social Care Bill has spilled out beyond Westminster and is dividing professionals in the NHS. Even at this late stage the Bill’s passage through Parliament is uncertain.

Whatever you might think of the Government’s proposals, the financial challenge that predated them is now a reality for the NHS. It is also rapidly becoming...

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...

The NHS Trust sector is now forecasting a surplus of just 0.1 per cent of income in 2011-12, with seven NHS Trusts alone forecasting an operating deficit of over £180 million combined. This is a marked deterioration from previous years and casts further doubt over the sustainability of many NHS Trusts.

For a great many Trusts seeking solutions to entrenched financial problems, the preference has been to merge into ever bigger units. The notable exception being Hinchingbooke Hospital, where the private health care provider Circle takes...

Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".

The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.

When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need...

Andrew Lansley's woes are multiplying by the hour this week as efforts mount to block the Health and Social Care Bill.

Resistance might be expected from the British Medical Association (BMA) and the Royal College of Nursing (RCN) and other unions, but it is now more widespread and even reported from deep in his own party, among cabinet colleagues. The public are bewildered and staff in the service doing a difficult job while debate rages and the...

I got an encouraging letter from the Secretary of State responding to our and The King’s Fund’s analysis on how integrated care could be developed in England. Our publication and other bits are a synthesis of what we know, with some concrete suggestions on how to move ahead.

There is now a tailwind, and the Department of Health, NHS Commissioning Board and Monitor are currently mulling over how best to respond. More on this in the spring.

Meantime, for those weary of Kaiser and Torbay as examples, The Commonwealth Fund this...

The main question raised by our newly published research report: Can NHS hospitals do more with less? is why, when so much is known about what drives and can improve hospital efficiency, is there still so much variation across, and sometimes within, individual hospitals?

The areas highlighted for action read like the contents list of a textbook of health care management, with topics such as: ensuring that length of stay and day case rates are in line with international best practice; exploring ways of using new technology to improve hospital...

OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

Alan brings together his long experience of analysis in the US, and his...

I have been in Boston for a few months now, and the weather has turned.  We were robbed of a spectacular New England Fall. Some blamed the hurricane; some the earthquake; the more scientific amongst us, the temperature.

Fall was delayed as the chlorophyll rich leaves persisted due to the stimulation of an atypically warm and sunny October/November. After weeks of patiently waiting for the leaves to change colour, they changed abruptly and fell almost without anyone noticing.

Around the same time, Don Berwick was quietly making ready his notes for his successor as he was...

‘Integration, integration, integration’ may not yet be on Channel 4 at 8pm on a Wednesday night but it is right up there on the agenda of the NHS.  It’s a central theme of the Health and Social Care Bill; it’s one of the key areas for the Future Forum’s second listening exercise; and perhaps, to quote Chris Ham, “it’s an idea whose time has come.”

Our involvement with the Nuffield Trust, participation in the listening exercise and in the newly convened ‘Integrated Care Discovery Community’ here in the northwest, has given us...

In September, Andrew Lansley accepted the Independent Reconfiguration Panel’s recommendations to proceed with changes to services at Chase Farm hospital in North London. These changes continue to be very unpopular locally, but as the Secretary of State’s statement acknowledged, these were hard choices about the safety and sustainability of services. And then he added: “This is not about money. We are not making cuts to local services.”

Whether or not local campaigners agree, this statement...

It is a year since the Government published the outcome of the Spending Review and so fixed public spending allocations for the four years from 2011/12 to 2014/15. The Spending Review led to an 11% reduction in departmental allocations across government (IFS summary of Spending Review, Oct 2010). Health received a comparatively generous allocation with a small real terms increase (0.4% over the four years). 

A year on we have...

The Future Forum has put integrated care at the heart of NHS reform. But who will ensure that integrated care is not crowded out by the emphasis on competition and any qualified provider, and what can clinical commissioning groups do to stimulate providers to work together to meet the needs of patients?

New research I have undertaken with Judith Smith and Elizabeth Eastmure draws on the experience of primary care trusts (PCTs) to suggest some answers to these questions. The research surveyed PCTs in England to understand how they were using their leverage as...