NHS reform

Well, we know when dealing with Government that rhetoric can outrun reality. Whether it's Blair or Cameron, they are eloquent on the need for an expansion of the third sector.

And, let's face it, given the challenges of long-term conditions and the preponderance of the elderly in hospital beds, we know a major expansion of charity and social enterprise provision is the bedrock of reform.

The recent evidence from the Foundation Trust Network (FTN) on ...

The impact of immigration on the NHS has long been a contentious topic and the Queen's Speech last week, which outlined plans to restrict migrants' access to NHS care, has thrust it into the headlines once again. Yet hard data on the issue have sometimes been thin on the ground.

In 2011, the Nuffield Trust published an analysis that looked at how often international migrants to England use hospital care in comparison with English-born people.

To our knowledge,...

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...

The release today of a crucial report written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC) sets out the challenges that face primary care and general practice.

In particular, the report looks at moving from a purely curative and reactive based approach to patient care, to one that is balanced against making significant inroads into the reduction of the rise in chronic ill health set against the backdrop of an ageing population.

As the NHS struggles to meet unprecedented financial efficiency...

This is a critical time for the NHS, with many key themes to discuss. But my start to the year is dominated by emergency care – a very practical challenge but one that raises important questions about culture too.

Across the NHS we are really struggling with emergency activity. Even allowing for Norovirus and prolonged cold weather we are experiencing unusual pressure.

The...

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-...

When I arrived in Boston as one of the 2012-13 Harkness Fellows I had no idea what learning I would want to bring back from the US health system to the UK. The Fellowship provides a wonderful opportunity to stand outside the UK as well as the US system and look at the strengths and weaknesses of both.

The greatest strength that I have so far seen in the US system is a genuine commitment to innovation.

This came into focus, for me, at the 24th annual National Forum of the...

Never in the field of NHS re-organisations can so many have left so few. Well, not literally. But April 1 sees some 160 NHS organisations, including all primary care trusts and strategic health authorities, abolished as hundreds more – 211 clinical commissioning groups plus a clutch of new national bodies and their regional arms – come formally into existence.

The result is what must be an unprecedented turnover of NHS chief executives. Some retiring, some moving on to other jobs, some taking redundancy, some leaving the direct employment of the service, some willingly, some not....

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...

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...

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...

In a speech to the Nuffield Trust a few years ago, the then-Secretary of State for Health, Andrew Lansley, turned to the failings of care at Mid-Staffordshire to motivate his argument for reform.

In defending the cause of clinically-led commissioning, Lansley said: ‘where were the GPs? I’ll tell you: the GPs were there, they sent the patients to the hospital’ but too often they had a culture of ‘refer and forget’.

One of the questions asked by the Francis Inquiry has been: ‘where were the primary care...

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 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...

As clinical commissioning groups (CCGs) prepare for 1 April, one has to wonder how ready they really are to take full responsibility for local strategic planning and purchasing of health care.

The coming year will be one of immense challenge in terms of the quality and safety of health care, particularly in light of the Francis Inquiry’s call for a fundamental change in NHS culture.

And all of this at a time when NHS funding is flat and the NHS Commissioning...

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...

Health care reformers tend to focus attention on hospitals and payment systems and yet primary care, where most patients are seen, receives comparatively little attention.

While it is acknowledged that hospitals are now poorly suited to the different types of patients they have to treat, the fact that primary care faces similar problems is rarely acknowledged. The recent Nuffield Trust European Health Summit, supported by KPMG sought to redress this balance.

Across Europe, primary care is often characterised by small and isolated practices, with few...

There is almost universal agreement that the social care system needs urgent and fundamental reform. Despite this consensus the various attempts at reform over the last 20 years have all stalled.

Against that background Andrew Dilnot could have been considered either brave or foolhardy to accept the Government’s request to head the latest commission on reforming social care funding in 2010. Last year when it looked like the Government was planning to kick funding reform into the long-grass once again, the evidence pointed towards...

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 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...