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...

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,...