Starting in April 2014 the 56,000 people eligible for NHS continuing health care will be offered a personal health budget. Positive results from an independent evaluation of a three-year pilot programme provided sufficient evidence to take the approach forward.

However, while the pilot programme has generated a lot of knowledge about how best to implement personal health budgets, important questions about how they can be sustained in the wider NHS are raised by next year’s roll out. These will need careful consideration as the roll...

Today we publish our response to the Care Quality Commission’s (CQC) consultation on changes to the way it inspects, regulates and monitors care services: A New Start.

Our response builds on the findings from our review of provider ratings, commissioned by the Secretary of State for Health, as well as drawing on the expertise of various members of our team with a past in regulation.

...

It is clear that Jeremy Hunt does not want to take on the role of Secretary of State for Health as envisaged by Andrew Lansley, and as designed in the Health and Social Care Act 2012.

Confined to public health, focused on health outcomes, and at arm’s length from the NHS through the annual mandate – this was never going to work under normal circumstances, never mind when an election is looming and with the budget settlement for the NHS as it is.

The Secretary of State will want to direct and...

You attend a hospital with your disabled daughter. You do this pretty much every day because your daughter has regular seizures and emergencies. Every time, you have to start all over again because the hospital doesn’t know who your daughter is. More paperwork.

Then you wait and wait because the staff have to find a hoist to lift your child out of her wheelchair onto a bed. Why couldn’t you have called in advance to tell them she was coming? Hours and hours of waiting.

This is the NHS in the experience of one mother I met recently: everyday indignities and inhumanities and, in...

Much has been written about the current pressures facing primary care. Perhaps it seems fairly predictable therefore, to hear that many GPs are finding it difficult to engage with the clinical commissioning opportunity.

But unfortunately for CCG leaders working hard to increase involvement, it is the support and involvement from members that provides one of their greatest potential assets.

So how big do GPs think the challenge is ahead? New research, along with a growing body of evidence, may provide a few tips.

...

Looking back over recent blogs about primary care written by Jonathan Tomlinson, Clare Gerada, John Macaskill-Smith and Helen Parker, three things stand out.

First, there is consensus that general practice is under significant pressure, struggling to meet demand from patients, blamed for contributing to the alleged crisis in accident and emergency care, and exhorted to reassume responsibility for out-of-hours patient care.

Second, the ‘special sauce’ of general practice – the relationship between a patient and their family...

We are in danger of losing our collective nerve over the future of the NHS. In 1948, in the midst of austerity and post-war national exhaustion, Britain created a comprehensive health service which offered care to those who needed it regardless of their means.

It was a courageous idea whose time had come and it made compelling economic, political and social sense. It still does.

In 2013 our far richer country can and should continue to embrace Aneurin Bevan’s vision. Of course we face very different...

I have lived and worked as a GP in densely populated urban areas for the last 12 years and so I read with interest and dismay, Neil Bacon’s enthusiasm for the findings of the Competition and Cooperation Panel’s so-called: Empirical analysis of the effects of GP competition.

This showed that GPs with neighbouring practices less than 500 metres away made fewer referrals for certain conditions and had patients who were 0.1 per cent more satisfied than patients from...

The NHS is struggling and general practice is one area bearing the brunt of the pressure to meet increasing, and changing, patient needs.

We have a growing and ageing population in the UK. From a GP’s point of view, we are seeing more patients than ever before, making up to 70 patient contacts a day, which previously would have only been seen in exceptional circumstances, such as a flu pandemic.

And these patients are often presenting with complex, chronic and multiple conditions, both physical and mental.

Additionally, another round of...

Tender, fragile, fragmented, strained, vulnerable. In disarray. At a cross-roads. These are just some of the words used by key contributors to the Nuffield Trust’s latest publication: The wisdom of the crowd: 65 views of the NHS at 65.

The service has never been particularly good at celebrating its big anniversaries. The tenth, in 1958, was pretty much all sweetness and light. But most of the others – from the 20th through to the 50th – were overshadowed by one crisis or another, by a sense of foreboding, or by both.

By contrast, the 60th, back...

It appears that the founding principles and aspirations of the NHS remain largely intact, but they are under great and increasing strain. This relates in part – but only in part – to increasing demands and costs brought about by demographic change, high expectations and new therapeutic opportunities offered by technological advance.

But these factors are not the sole cause, nor in the views of patients, public and staff are they the most important.

As the Francis Inquiry – the latest of several into shameful events – has so painfully shown, unless...

The Chancellor announced the outcome of the 2013 Spending Review yesterday. He confirmed that the NHS has been spared the full force of Government cuts for another year. The health budget is rising in headline terms by just 0.1 per cent after inflation. As expected, part of the health budget is earmarked to be transferred to social care.

This continues the precedent established in the 2010 Spending Review which set aside money each year for...

If we stand back now, the NHS may tip over the edge of its own ‘fiscal cliff’. Future health care services face serious challenges such as changing demographics (particularly ageing), increasing obesity levels and rising costs of new treatments and medicine.

To do nothing about the increasing demands being placed upon the system would be a political mistake.

I believe that the current infrastructure, and the widespread and relatively unchallenged acceptance of a service funded solely by the taxpayer, will lead to poorer patient outcomes than we should...

Clinicians and health service administrators can often identify ways of reconfiguring services, particularly hospital services. These reconfigurations usually appear to deliver improved outcomes but prove hard to sell to a sceptical public. On these occasions, local politicians are urged to be brave and support such moves.

All too often though, the politician is found fanning the flames of popular discontent and those inside the NHS look upon them with varying degrees of sympathy, bewilderment, despair or contempt. The situation is actually made worse if health insiders believe that...

The litany of challenges facing hospitals is by now familiar: rising demand, spending restraint, making the best use of new technologies, and finding ways to adjust the acute sector to a world of chronic illness.

A service that has struggled to make progress on productivity for decades now faces a future in which there will be no alternative but to make steady efficiency improvements, year on year, while at the same time maintaining a level of quality upon which vulnerable people depend.

The task is daunting, but I remain an...

Long-term services and support (LTSS) primarily refers to personal care services that include home help, care in nursing homes and assisted living, as well as day care.

Of the 13 million Americans that need long-term care, only 13 per cent have received help in paying for these services. The situation is set to become even more challenging, as the proportion of Americans over the age of 65 is...

A week after the Government's integrated care pioneer programme kicked off, the evaluation of North West London's integrated care pilot was published. The ingredients of the pilot were sensible, for example: investment in IT, risk stratification and targeting of high risk patients, leadership, coordination of multidisciplinary groups, and project management.

The results so far: high commitment by professionals; greater collaborative working across teams and with social...

I once worked with a consultant who had an uncanny ability to extract the truth from his junior staff. When he suspected dubious information (such as “I’m sure the patient had a high erythrocyte sedimentation rate (ESR)”) he’d say, “Is that a guess, rumour, fact or lie?”

Of course, he did it in such an intimidating manner that the answer was clear by the blood draining from the face of the poor, unfortunate wretch who didn’t have all the information to hand.

The current debate about the absolute need to reorganise and improve the NHS often reminds me of that consultant’s total...

General practice seems to be considered by politicians and the media as both the cause of and solution to the current crisis in demand for urgent and emergency care.

At the same time, the primary care community is recognising that the current business model of general practice is under threat due to increased demand by patients, growing regulatory workload and, for some this year, significantly less income.

From discussions with GPs and policy makers, there appears to be some consensus that the current ‘small scale’...

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 ...