The Nuffield Trust, like many organisations, is inundated with requests from people working in the NHS who want help to evaluate improvement initiatives; a subject already touched upon in a recent blog by the Nuffield Trust’s Alisha Davies.

These requests highlight a big problem; demand for evaluation is increasing but the supply of expert evaluators is limited. So the Nuffield Trust organised a conference bringing together evaluators, commissioners of evaluation and potential users of evaluation learning to...

Evaluation is on everyone’s lips these days as the plethora of new and existing initiatives, such as Integrated Care Pilots, the Better Care Fund and most recently the Vanguard sites are under scrutiny to show that these new models are actually delivering on their promise. Like the attendees coming to our Evaluation of complex care 2015 conference you may well be grappling with the question of whether a Randomised Controlled Trial (RCT) is a possible way to evaluate the complex, community based...

There is an awful lot of interest in evaluation at the moment – no bad thing for us at the Nuffield Trust, given that we have a long track record in certain types of evaluation.

Most recently, NHS England have said that the new Vanguard sites, new models of care described in the Five Year Forward View, will need to show “a commitment to co-design local and national metrics and to demonstrate progress against them, including...

This week a study in the Lancet concluded that phone consultations with patients who request same-day appointments generate additional work for GPs when compared to face–to-face encounters. In some ways, the study provides further evidence for the existence of induced demand – the phenomenon that widening access for health care fuels use – that we highlighted in a recent Nuffield Trust report (June 2014).

If patients can’t have all of their care needs...

The concept of predictive risk, or using linked person-level data to identify the patients most likely to have future unplanned hospital admissions, is now firmly embedded in the NHS. Here at the Nuffield Trust we recently held our fifth annual conference on the topic.

One of the joys of holding an annual event on the same subject is that it provides an opportunity to see how things change from year to year, and it is certainly true that the world of risk stratification has come a long way over the past few...

A recently published Nuffield trust report offers a fascinating insight into the routes that cancer patients take through the care system. In an era that promotes integrated care we all accept that caring for a person extends beyond one organisation; and treatment for cancer may include primary, community and social care on top of acute hospital activities.

However, it is notoriously difficult to see what services patients are using as our information systems are usually so disjointed. Yet as this report shows it is now possible to...

Hospital readmissions for emergency care have been the subject of policy attention for a few years. The common view is that they are preventable by a better standard of care; however the reality is much more complex.

Our research, published in the Emergency Medicine Journal, throws some light on this reality.

We looked at 83 million hospital admissions in England using data sets spanning all NHS hospitals over a 10 year period. The team looked at patterns of readmission within 30 days, at an individual level. These large data sets make it...

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...

Implementing new models of care is not easy – and especially so when organising community-based services that aim to tackle the challenges of more chronic disease and greater levels of emergency care.  

One of the more interesting approaches of the past few years has been the Virtual Ward and we recently published a report, funded by the National Institute for Health Research Service Delivery and Organisation Programme, looking at three early examples of Virtual...

After several years in gestation, the Whole Systems Demonstrator (WSD) trial of telehealth is now producing a steady stream of outputs – most recently in the form of a paper looking at whether telehealth changed the frequency with which people used GPs and practice nurses.

The WSD, one of the largest trials of its type in the world, focussed on one use of telehealth as a form of remote monitoring and support to help people better manage their chronic health conditions – which in this study meant either...

The quality of NHS care has been scrutinised in the past year probably more than in any other since its birth. We are contributing to this debate by launching QualityWatch – a programme to look at how quality of care in England is changing.

The past two years have seen a series of reports detailing high-profile failures of care or concerns about other potential ones. It is clear that assessing quality is of increasing importance to an increasing number of organisations, both...

Approximately £40billion of total NHS expenditure in 2011/12 was spent on local contracts for services that do not have nationally mandated prices. Until now little research has been done to assess just how effective these have been in delivering more for patients, with the focus being on national price setting.

Recent Monitor research highlights that pressure on local commissioners to balance annual budgets may limit their potential to drive better quality care for patients through local contracts for...

The Nuffield Trust has just published a paper on a new predictive model. We hope that the paper and the accompanying details can help both commissioners and providers of care refine the ways that they use risk stratification and case finding tools.

The market for predictive modelling tools has grown a lot in the last few years. Alongside the old familiars, such as Patients At Risk of Re-hospitalisation (PARR) and the...

Health services around the world are attempting to improve care for people with long-term conditions, as currently it is often fragmented and expensive. Many interventions have been tried and tested. To the long list of evaluations another can now be added – that of Birmingham OwnHealth (published today in the BMJ).

Birmingham OwnHealth was England’s largest example of telephone health coaching, established in 2006. Operating as part of...

The Nuffield Trust recently held its fourth annual conference on predictive risk - or applying statistical models to populations in order to identify patients who might benefit from health interventions of various kinds.

The mere fact that this was the fourth conference on the subject shows that this is an idea with legs. And, indeed, it has just been given a boost by the Department of Health, which has included a directed enhanced service for ‘risk profiling and care management...

Over the past four years the Nuffield Trust have been asked to look at a range of service innovations and assess whether they lead to a change in service use – most typically a reduction in inpatient hospital activity, which is something that seems to have become the holy grail of health service planning.

Our new report summarises observations from our studies and efforts that might help those planning and evaluating new services in the future. In particular, the report should provide useful learning for the new...

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...

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...