Frontier Economics hosted a roundtable discussion at the recent Nuffield Trust Health Policy Summit to discuss the development of economic regulation.

We drew some (only some – yes, health care is different) inspiration from the experience of other regulators. The early days of Postcomm – the postal regulator overseeing a government-owned Royal Mail – provided some lessons.

Postcomm reached for the standard regulatory toolkit but found itself foiled by a publicly owned Royal Mail who accumulated losses year on year. Sound familiar? In the end the...

“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...

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...

The Budget 2013 confirms that funding for health in England will be frozen in real terms for a further year – up to 2015-16 – and the requirement to under-spend allocations is here to stay. The Government has also extended the one per cent cap on pay awards for a further year and is talking about limiting pay progression.

This is hard for NHS workers but will be a big help to NHS organisations trying to match the money with the pressures on services.

After 2015-16 the Office for Budget Responsibility’s...

The first day of last week’s Nuffield Trust Health Policy Summit concentrated on the linked issues of quality and finance.

It’s clear we are going to have to improve the amount of the former whilst having less of the latter.

I will return to that issue, but throughout my time at the Summit I couldn’t get away from the idea nagging at me that here we are in the spring of 2013 and now, right now, would have been a great time to launch an NHS reform programme from the Government.

Following...

Back in 2002, I learned a valuable lesson: The patient’s view is paramount.

Building user involvement in Motor Neurone Disease was a service improvement project at King’s College Hospital that included an in-person support group, newsletter, dedicated telephone group, and an online asynchronous message board or ‘forum’.

As the lead researcher wound down the project, the team found there were two young patients, diagnosed in their early 20s, still using the forum to communicate.

That’s when I...

For the third year running, we have carried out a small, snapshot survey of the NHS amongst the policy makers, senior managers, academics and clinicians who are attending our forthcoming Health Policy Summit, which takes place on 7 and 8 March.

This survey does not pretend to be representative in any way, but nevertheless provides a flavour of opinion amongst the 53 people who responded, in the wake of a year which has brought prolonged gloom about the prospects of improvement in the state of public finances and the passing and...

The report of the public inquiry into Mid Staffordshire NHS Foundation Trust has focused our attention on the quality of care provided in hospitals.

The Inquiry was however about the wider NHS system and its ability or otherwise to spot and address failure. Indeed the list of witnesses to the Inquiry underlines the extent to which this wider system includes commissioners, regulators, policy-makers and local general practices.

Robert Francis' analysis of the events at Mid Staffordshire includes...

Amongst all of the health reform activities in the United States, the formation of accountable care organisations (ACOs) is considered one of the more promising for bending the health care cost curve while improving patient outcomes.

ACOs are comprised of a group of providers who are held accountable for the cost and quality of care for a defined population of patients.

Successful ACOs are expected to manage costs by aligning incentives for hospitals,...

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...

The debate about price competition in the NHS is a very good example of a more general point: the impact of competition in health care will depend on the ‘rules of the game’.

The Health and Social Care Bill sets out some of the parameters for competition but much of this is of necessity very broad and open to interpretation.  This job of interpretation falls largely to the new economic regulator – Monitor.  Its approach (or regulatory stance in the jargon) will have a profound effect on the way competition evolves over the coming years.

The market mechanism session of...

Is it time to move beyond commissioning? This was the question posed by Dr Judith Smith  to the panel in a debate session at the Nuffield Trust’s annual Health Strategy Summit 2011.  The question arose from a cool appraisal of the research evidence on 20 years’ experience of NHS commissioning in England – evidence which points to very limited impact by commissioners on secondary care, and a struggle to make the shift to community-based care that has been long exhorted in policy.

Judith highlighted some persistent problems with...

Andrew Lansley, the Secretary of State for Health, arrived at the Nuffield Trust summit intending to announce some new developments in Payment by Results.  But the questions and debate following his speech came to be dominated with other questions, including whether the government really plans to introduce competition on price and abolish mandatory NICE guidance in the future.

The audience was rewarded with clarity on the first question. There would be no competition on price, he explained. There...

Most interactions you might have with any organisation leave behind a trail of data. In health care, these datasets have many uses and the Nuffield Trust is interested in ways that we can exploit them to inform health policy.

We are particularly interested in how linkage between data sets can reveal a fuller picture of what is happening to people as they use services.  We refer to this as a “data laboratory”, and use this in evaluation and in developing models that predict the likelihood of future events. 

Session three of the Nuffield Trust’s 2011 Health Strategy...

This morning I logged in to my bank account on my smartphone, checked my balance, transferred some funds, and rated the service received for a book that I ordered online—all before my morning shower.  I then sent an email to my boss explaining that I would be late today because it was going to take me most of the morning, including travel time, to attend a ten minute follow-up appointment at my local outpatient clinic. Why is health care so far behind the times?

This was the topic we recently explored at a breakfast session at the Nuffield Trust’s 2011 Health Strategy Summit....

The quest for better, more efficient health services requires innovation, new ways of working and new behaviours across every area of care. The message from the summit was that innovation and change will flow from everywhere – patients, individual clinicians, managers and large organisations.  

We were challenged at the start of the conference by two proponents of the Big Society, Phillip Blond of ResPublica and Geoff Mulgan of the Young Foundation. Phillip Blond argued that innovation would flow if the NHS can avoid capture by the private sector and instead actively foster...

The third annual Nuffield Trust Health Strategy Summit takes place this week, bringing together senior health leaders, academics and clinicians for two days of reflection and debate on the NHS.

The imminent reforms to the English NHS and the challenge of delivering £20bn efficiency savings form an imposing backdrop to the discussions, and will no doubt provoke much debate and comment, but the summit’s ambition is to look past the headlines and grapple with some of the bigger issues that lie beyond. 

The tangle of ideas that make up ’The Big Society’ will be unravelled and...