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 becoming the...

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.

The...

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...

My start at the Nuffield Trust coincides with the anniversary of the new system and Simon Stevens’ first week in charge of NHS England.

I’ve been spending time on international work for the last two years and have been somewhat concerned by the nature of the debate on health and social care recently.

The first reason is that there is too little public discussion about the solutions to the financial challenges facing social care and the NHS.

There is a shared view that 2015/16 is going to be tough. We also...

Since clinical commissioning groups (CCGs) moved into the driving seat of the commissioning system 12 months ago, the breadth of the job they are expected to do has become apparent.

Responsibility for each of the big changes we are increasingly told that the NHS needs – better joint working with social care, further efficiency savings in hospitals, and radical change in the scale and scope of general practice – rests largely on the shoulders of CCG leaders as the key drivers of change.

It is the last point – the involvement of...

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...

While this week’s Budget contained no new announcements on health spending, it shone a harsh light on just how tough the financial challenge is proving for the English NHS.

The chart below from the Office for Budget Responsibility (OBR) shows how Government spending on the English NHS is falling as a share of UK GDP – from 6.5 per cent of GDP at the end of the last decade to 6.2 per cent in 2015-16. Health spending as a proportion of GDP last fell in the late 1990s and before that in the late 1970s – in both cases to be followed by major programmes of reform...

Today’s Budget contained no new announcements when it comes to health and social care. While the continuation of austerity beyond the next election will almost certainly mean more tough decisions on public spending in the next spending review, today was all about warming up to electorate for the election with eye-catching policies on tax and pensions.

The big news as far as the NHS is concerned had already been announced: last week the Government set out its decision on NHS pay over the next two years.

NHS staff in England who receive incremental pay award will not have any...

“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...

MBA students in the United States are now taught about the Mid Staffordshire NHS Foundation Trust Public Inquiry as a case study of institutional behaviour when leaders lose sight of their values. Will they one day also use the Care Quality Commission (CQC), as a case study of just how fundamentally a failing institution has to change?

I know it’s stating the obvious, but I’m still amazed at how wrong decisions about the direction of an organisation (that are often relatively quick to make) can take literally years to turn around.

Last week the CQC...