Ahead of the launch of our fourth Health Leaders Survey tomorrow, Dr Jane Collins, Chief Executive at Marie Curie and member of the panel blogs on the role of the voluntary sector in the NHS.

People often talk about the role of the voluntary sector in the NHS as though this is somehow a new or unusual thing, but actually Marie Curie and many other voluntary sector organisations have been around for as long as the NHS – some longer – and have proven expertise in delivering high quality care and support.

People also often talk about services provided by...

Access to hospital care: is the NHS on target?

sarah.wilson 13 March 2015
Nuffield Trust
13 Mar 2015

Our fourth policy briefing in the run-up to the General Election 2015 examines how hospital trusts in England are performing against six national targets. The paper argues against the notion that dips in performance can be attributed to a handful of poorly performing hospital trusts, and finds there has been deterioration across the board in some measures.

In the run-up to the General Election, we are producing a series of policy briefings on the issues and challenges that are critical to the longer term success of the health and social care system  the issues any Government after 2015 will need to prioritise.

Access to hospital care – is the NHS on target? looks at how 156 hospital trusts in England have performed against six national targets over the course of this Parliament. The targets examined are: the four-hour A&E target; the 18-week target for a hospital bed (inpatient treatment); the 18-week target for an outpatient appointment; the six-week target for diagnostic tests; the two-week target for urgent cancer referral; and the 31-day target for cancer treatment.

We’ve known that hospitals have been struggling to meet the four-hour A&E target for a while. But the fact that we are starting to see problems in other areas, like access to planned treatment, is a real concern. As this study makes clear, warning lights are now starting to flash across the wider hospital system.

Holly Dorning, Research Analyst and report co-author

The briefing, authored by Holly Dorning and Ian Blunt, highlights the variation between the top and bottom ten percent of hospital trusts and casts doubt on the idea that problems overall are caused by a series of local or managerial failings, and suggests instead that they are likely to be more systemic. As the briefing looks at the national picture affecting hospital care, individual trusts are not named.

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Clinical Commissioning Groups (CCGs) – now approaching their second birthday – are having to grow up fast. They have cut their teeth on community and acute services, and now have the option to take up further responsibilities.

Up to half of the country's CCGs have applied for full delegated responsibility for commissioning primary care (Level 3). An estimated 10 per cent are likely to opt for '...

Risk or reward? The changing role of CCGs in general practice

sarah.wilson 13 January 2015
Research report
Nuffield Trust
26 Jan 2015
Ruth Robertson
Shilpa Ross
Laura Bennett
Jeni Gosling

As clinical commissioning groups (CCGs) settle into their central role in the reformed NHS, the full scale of the challenges they face is becoming clear. This report, part of a joint project by the Nuffield Trust and The King’s Fund, aims to understand the development of CCGs, and to support them by spreading good practice and learning.

It tracks the development of six CCGs, selected to broadly represent CCGs across England. The report, which is based on a survey, interviews, observations and reviews of board papers, considers two research questions: how CCGs are functioning as membership organisations and how they are supporting the development of primary care in their local area.

“Our research shows that the future of the clinical role in commissioning healthcare remains fragile. While CCG leaders overall are still highly engaged in their work, our fieldwork and survey revealed this is waning and there are some worrying signs emerging over strained resources – both time and money. CCGs are set to be stretched yet further as they adapt to new and expanded roles.”

Holly Holder, Fellow in Health Policy, Nuffield Trust and report co-author

The report authors found that:

  • CCG leaders questioned whether they had sufficient capacity to expand into primary care commissioning.
  • While the majority of CCG leaders felt that conflicts of interest were being managed adequately, researchers highlighted examples of decisions where there was the potential for conflict.
  • Few GPs felt that managing GP performance – something that contract management responsibilities under co-commissioning may lead to – was an appropriate role for CCGs.

The study outlines a number of key recommendations to CCG leaders and NHS England to assist CCGs in making the transition to co-commissioning and ensure the sustainability of CCGs. 


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Eighteen months ago, the protection of NHS spending was not a popular position in Whitehall. Other departments, cut to the bone and facing more of the same, were envious. Politicians as different as Vince Cable, from the Lib Dem left, and Phillip Hammond from the Tory right, lobbied hard for the health service to “share the pain”. In Paris, the OECD called on...

In my clinic last Friday I was shocked: four out of sixteen appointments were taken by patients who were unable to gain access to the hospital services they had been told they needed. Having each tried to contact the hospital several times, they came to me to ask for help in navigating hospital booking systems, for interim pain relief, and reassurance. GP appointments that should have been available for clinical problems were used for administrative support, alongside clinical advice on the symptoms that arose from delays in care.


It’s the report the NHS has been waiting for. 

Simon Stevens’ vision for the future of how care will be organised and delivered in England is set out in the Five Year Forward View – the first time the arm’s length bodies in the NHS have come together to produce such a report. 

Just as he did when creating The...

A number of organisations have been arguing that there needs to be a transformation fund to support change in the NHS.  

What they are picking up is something that is very noticeable when comparing the NHS to other sectors and to health systems in many other countries – the absence of a banking function or mechanisms to support organisations while they restructure. This is how the asylums were closed and community mental health services developed.  

Fixing this is important. The process of change is long, often uncertain and will mean that some organisations running...

I am writing this from my hospital isolation room having just had a stem cell transplant that will I hope cure my dysfunctional bone marrow. The transplant and the care that goes with it is a tremendous fusion of compassion, research, pharmaceutical development, attention to detail, dedicated caring professionalism from the unit director through to the receptionists, significant voluntary sector input largely from the Anthony Nolan Trust but also in funding of hospital facilities, and international cooperation.

There is no suitable donor for me on the UK registry. But the much larger...

There has been a lot of concern expressed about the planned free trade deal between the European Union and the US, the Transatlantic Trade and Investment Partnership, and the impact it will have on the NHS.

TTIP seems to combine a number of popular demons in health circles: privatisation, US healthcare, competition and Europe. The fact that the Department for Business, Innovation and Skills is leading UK negotiations on behalf of the NHS might also make those who remember the Working Time Directive nervous.

So just how big a threat is TTIP to the way the NHS works? The...

The Health Secretary has quite a difficult job. He is charged with encouraging quality improvements in the NHS while it is, as the Nuffield Trust’s report Into the Red? shows, under considerable – perhaps unsustainable – financial pressure.

As the new two-part edition of my book on the history of the health service From Cradle to Grave, or the Nuffield Trust’s interactive timeline show; providing a high-quality,...

Our report, Into the red? The State of the NHS’ finances, sets out the facts on NHS expenditure between 2010 and 2014. It is clear on figures for 2013/14 from Monitor and The NHS Trust Development Authority, that, subject to audit, NHS providers will post a small overall deficit of £100 million. Equivalent figures from NHS England show that the commissioning side will produce a small surplus. The overall result for the entire NHS is likely to be happiness in Mr Micawber’s terms....

Last week was a landmark: a new competition authority (the Competition and Markets Authority (CMA) – itself the consequence of a merger) approved the first full merger of two NHS acute trusts. Their decision will allow the merger between Frimley Park Hospital NHS Foundation Trust and Heatherwood and Wexham Park Hospitals NHS Foundation Trust to proceed.

The competition authorities are quick to point out that this is the third NHS merger they have approved since the passage...

On June 9, I finished my ward round of 24 inpatients – median age 80-plus, legged it to the station and got into London just in time to set up my workshop on models of care for frail older people at the Nuffield Trust Future Hospitals conference.

At the event, I presented some challenging ‘home truths’ alongside an animation and some practical solutions.

The “home truths”

Sometimes, people who feel they are challenging orthodoxies end up...

NHS England Chief Executive Simon Stevens issued his challenge to rethink the role of the hospital in more imaginative ways after this week’s Nuffield Trust’s conference on the future of the hospital was already in the diary.

There were some clear lessons from our audience of hospital leaders – many on the theme that simple answers of hot-cold splits (separating emergency from elective care), centralisation, mergers etc are not working. I took away a number of lessons:

Decisions need to be made about where to focus: smaller hospitals...

The response to NHS England Chief Executive Simon Stevens’ first interview says as much about the challenges facing the NHS as the content of the interviews themselves.

Mr Stevens’ message – to be pragmatic, to decide what’s right locally, to be bold, and to look beyond current bricks-and-mortar configurations – quickly transmuted under the media spotlight into one of harking back to a bygone age of cottage hospitals.


As the noise generated by last week’s local and European elections fades, political energy will now be directed towards defining the policy battlegrounds on which next year’s General Election will be fought, which will have to be much wider than immigration and the European Union.

Even though the NHS is so central to politics in the United Kingdom, predicting how noisy an issue it will be in the run up to next year’s General Election is difficult. This is partly because of its peculiar status, at least in the minds of politicians, who believe that the voting public has an essentially...

Yesterday's Guardian reports that the Government’s plans for the Better Care Fund have been put on hold as the Cabinet Office demand that the Department of Health do more to explain how the savings needed to pay for it will be secured. Government sources have been quick to dampen speculation that this signals trouble for the plans.

But the question reportedly asked by the Cabinet Office is exactly the right one, albeit at an odd time, as the Bill to set up the Fund is...

Simon Stevens’ first appearance in front of the Health Select Committee has produced some interesting changes in tone.

He is less inclined to see competition as a barrier to change than his predecessor, hinting at a more pragmatic approach to how it is used.

He struck a note of realism about how far we can expect the Better Care Fund to reduce emergency admissions. And he seems to have a more nuanced view about hospital reconfiguration than we have heard so...

Criticism of the Welsh NHS is a popular sport for English ministers. David Cameron takes regular pot shots at longer waiting times and failure to hit A&E targets.

To the politically cynical, it looks like a straightforward attempt to brand Labour, who governs in Wales, as a party that cannot manage the NHS.

It may also be an attempt to show that the ‘English’ approach to managing the NHS, with the development of a market, competition and a variety of private, voluntary and other providers, is producing better results than that in Wales which abolished...