Mergers

The Francis report has pushed money well down the pecking order as quality takes first, second and third place.

But as we come to the end of the financial year some eyes will again turn to how well the service is maintaining financial balance, meeting the Nicholson challenge of £20 billion savings and raising quality.

We know that the NHS needs to increase productivity to make savings, raise quality and balance the books. The consensus is that NHS productivity flat-lined over much of the last...

The queasily thin amount of experienced medical cover in some hospitals at nights and weekends was the subject of BBC Radio 4's File on 4 last week. Juniors missing key symptoms and signs, not wanting to bother a consultant out of hours, with occasional tragic results or at best near misses.

Suggestions for remedy included making consultants work 24/7 rotas. I sympathised with the experienced paediatrician who predicted that would be the last straw for many who have given their all for the NHS over many years.

The...

Hospital mergers and reconfiguration are increasingly centre stage in the NHS. Several years of financial austerity, with more in prospect, is placing severe stress on hospital finances. The ability of hospitals to deliver the necessary annual cost reductions (in the order of five per cent per annum) through tactical savings schemes is fast diminishing.

Instead, more radical options for cost saving are being considered, including merger and major reconfiguration – as evidenced by the Department of Health’...

The Nuffield Trust’s new NHS reform timeline is a salutary reminder that the NHS, and health services internationally, teem with ‘wicked problems’.

A phrase originally used in social planning, this describes problems difficult or impossible to solve because of incomplete, contradictory, and changing requirements, often hard to define. Sometimes those seeking to solve the problems are also causing them. Often one wicked problem is merely a symptom of another one.

Solutions to wicked problems are better or worse, not right...

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 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...