Evaluation

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...

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-...

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...

Amidst all the shocking evidence about failures of staff, regulators and managers, there's a subplot to the Mid Staffordshire Inquiry that's received less attention. This is the failure of the vehicles supposed to convey patients' voices beyond the hospital, to the local public, patient and representative bodies.

Evidence to the Inquiry exposed how the arrangements for responding to complaints within the hospitals failed to deliver: many patients complained to PALS (the Patient Advice and...

The purpose of predictive risk modelling is to segment a given population on the basis of their risk of experiencing a particular outcome, for example an emergency hospital admission (Billings and others, 2006).

This is often used for case finding, where appropriate prevention techniques are matched to each risk stratum. High risk patients will be a small minority of the total population, and the form of the intervention will change depending on the level of risk.

The highest risk patients might receive a personal...

Telehealth is increasingly being advocated as a way to monitor patients remotely and better manage long-term health conditions. The Nuffield Trust was part of the largest randomised controlled trial in this area, “the Whole System Demonstrator” (WSD) – the initial results were published earlier in the summer.

We held a seminar with practitioners, researchers and funders to discuss the remaining research that needs to be done, post WSD. Priorities were identified as;...

There are three requirements for entrepreneurship to flourish: the capacity to invest and innovate; the autonomy to make decisions over resources; and the confidence that the fruits of success can be retained, either by the individual or the enterprise. Of course, these conditions are usually in place in properly functioning conventional markets, allowing entrepreneurs to invest, innovate and reap the rewards of success.

In a recent Nuffield Trust seminar however,...

In the Whole System Demonstrator (WSD) trial, a team of researchers studied the impact of installing telehealth technologies in patients’ homes to monitor their vital signs such as blood sugar levels. 

Debate continues over whether the findings justify the Government’s policy of encouraging the NHS to invest more in telehealth. At the same time, the trial has raised a potentially even more significant discussion. 

How useful are randomised controlled trials...

The first results of the largest randomised controlled trial on telehealth were published in the British Medical Journal last week. Of the five arms of the Department of Health-funded 'whole system demonstrator' (WSD) trial, the first (conducted by a team here at the Nuffield Trust) examined the impact on hospital admissions and costs.

The headline results so far: patients receiving telehealth care had just 0.14 fewer emergency admissions in the one year of follow up; and...

This week, the British Medical Journal published the first results from one of the world’s most complex randomised controlled trials. Researchers at the Nuffield Trust led this analysis, which relied on collecting over a billion records of administrative data from more than 250 health and social care organisations.

The trial’s aim was to evaluate “telehealth” – a way of using technology to support people with long-term health conditions such as diabetes, heart failure or chronic obstructive pulmonary disease....

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...

Earlier this autumn, I had the opportunity to visit the Hospital2Home virtual ward project in New York. Like other virtual wards, this project aims to reduce the risk of unplanned hospital admission for people at high predicted risk of admission. 

I was particularly interested to visit this project because it has strong partnerships with health care, social care and charitable organisations, and it cares for some of the most vulnerable people in...

I recently had the opportunity to visit the Toronto virtual ward as part of my Management Fellowship role working with researchers at the Nuffield Trust who are evaluating the costs and benefits of the virtual wards in Croydon, Devon and Wandsworth.

The virtual wards work just like hospital wards, using the same staffing, systems and daily routines, except that the people being cared for stay in their own homes throughout.

The purpose of...

Starting in April 2011, NHS hospitals in England will not be paid for “avoidable” readmissions occurring within 30 days of discharge.  As Trust finance officers begin steeling themselves for this change, they may be interested in a Canadian project designed to predict and avoid such readmissions. 

Known as the Toronto Post-Discharge Virtual Ward, the project borrows a concept first developed...