NHS reform

That the Government ducked the question of social care funding should have come as a surprise to no one.

Of course, the long awaited White Paper on social care and draft bill contained much to be welcomed. Individuals, families and carers will clearly benefit from standard eligibility criteria to access care nationally and the freedom to move without losing access; more personal budgets and better information could help make choice a...

Most developed countries have problems with the percentage of their gross domestic product (GDP) spent on health, so our problems are not unique.

The theory goes that in order to meet the challenge of future health care demand due to changing demography, lifestyle and new technology innovation, resources must shift into more community, home-based and self-service provision.

There appears to be consensus at the policy level that it is in the interest of patients and service users that a more integrated approach should be developed. Underpinning this is an assumption that...

Last week saw the release of three surveys looking at patient satisfaction with the NHS, prompting a flurry of comment and opinion.

The British Social Attitudes (BSA) survey, sponsored by The King’s Fund, saw a drop in overall satisfaction with the NHS from 70 per cent to 58 per cent. The Public Perceptions of the NHS research...

Like me, you may have ‘Government document fatigue’. Page upon page of optimism and bureaucratese after a while resembles looking at a blank wall. And life, after all, is too brief a spark.

Such were my uncharitable thoughts one hot evening this week settling down to read: The power of information: putting all of us in control of the health and care information we need. Yes, blancmange is in there, but the paper is the best attempt I’ve seen to weave together...

The Government spends some £140 billion a year on services for older people. The bulk of this pays for pensions and other welfare benefits, and NHS care. Just six per cent goes towards meeting the social care needs of older people.

If you were starting with a blank sheet of paper, would this look like the best balance of spending to ensure quality of life, dignity and respect in older age? Is spending so little on social care relative to health and cash payments meeting the needs of older people?

Is it the most efficient use of taxpayers’ money when we know that restricting...

As the dust settles following the passage of the Health and Social Care Act, one of the most absorbing questions for health policy watchers (apart from the process of implementation) will be how Labour responds, having fought so hard and long against the Bill. 

Should their policy be to repudiate the entire Act, or are there in fact elements which are sound and should be kept? This and other questions are now absorbing Labour’s Health Policy Commission, which is aspiring to build policy by consulting a...

Is it possible to have strong general practice (GP) ownership of a primary health care organisation, whilst pursuing a population health agenda? Geoff Meads termed this age-old tension between general practice and public health the attempt to mix oil and water.

In mineral-rich but water-poor Australia recently, I had a strong sense of déjà-vu about the general practice-public health tension.

Australia is setting up a national network of 'Medicare Locals' as part of wider health reforms. These new organisations will be responsible for planning more integrated, local primary and...

With the showers has come a certain malaise tinged with queasy uncertainty.

This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with respect to the mass reorganisation outlined in the now Health and Social Care Act.

The queasiness extends beyond health, look at local Government for example facing an average six per cent cuts rather than a ‘flat real’ settlement as in health.

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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...

Within the research group of the Nuffield Trust we have a number of studies that use the anonymised linkage of health and social care records. The results of one study are due to be published in the Journal of Health Services Research and Policy (JHSRP) soon but they have left us with a puzzle.

We found that from a population of older people (aged 75+) in four local authority areas, 14 per cent used some form of local authority social care over a one year...

Amongst all of the health reform activities in the United States, the formation of accountable care organisations (ACOs) is considered one of the more promising for bending the health care cost curve while improving patient outcomes.

ACOs are comprised of a group of providers who are held accountable for the cost and quality of care for a defined population of patients.

Successful ACOs are expected to manage costs by aligning incentives for hospitals,...

High stakes with the Health and Social Care Bill last week. But at our Health Policy Summit 2012 we pushed aside for a minute big reform, structures, and long run consensus-dividers such as competition/choice, public/private, and command versus autonomy.

Instead, we majored on – as guest Don Berwick so thoughtfully put it – ‘contextually adaptive changes’.

A physician who was formerly chief of the Centers for Medicaid and Medicare and the Institute for Healthcare Improvement, Don was upbeat that with the right changes...

Annual per capita growth rates in acute care costs are increasing fastest for older adults.

Given that this growth rate is expected to continually increase, it is imperative that we increasingly focus our efforts around developing new cost-conscious models that are also able to meet the complex needs of older patients.

The biggest problem is that our current hospital care model was developed years ago when most adults tended to not live past 65 or were living with chronic illnesses and usually only had one active problem that brought them to hospital.

While things still...

The Nuffield Trust’s fourth Health Policy Summit opens on Wednesday, bringing together senior health leaders, clinicians, policy-makers and academics. The timing is not auspicious.

The intense political wrangling over the Health and Social Care Bill has spilled out beyond Westminster and is dividing professionals in the NHS. Even at this late stage the Bill’s passage through Parliament is uncertain.

Whatever you might think of the Government’s proposals, the financial challenge that predated them is now a reality for the NHS. It is also rapidly becoming...

As the purchaser of health services for the British population, the NHS has always had to make hard choices about who is eligible for treatment, what services to cover and what criteria patients need to meet before treatment is administered.

In recent months in particular, there have been extensive debates about who bears responsibility for making these decisions and the basis on which they should be made.

These include questions about how the duties of the Secretary of State for Health should be framed, the extent to which the NHS Commissioning Board should...

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...

A centre-right coalition Government; an unsustainable hospital sector needing reform; an ageing population living with more chronic disease; calls for more integrated care; and a belief in the power of local clinical leadership to bring about such change. Sounds familiar? Well, up to a point.

Here in New Zealand, where Carol Black and I have been taking part in the Royal New Zealand College of General Practitioners' Quality Symposium, you have to pinch yourself, such is the commonality of much of the debate about our...

Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".

The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.

When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need...

Andrew Lansley's woes are multiplying by the hour this week as efforts mount to block the Health and Social Care Bill.

Resistance might be expected from the British Medical Association (BMA) and the Royal College of Nursing (RCN) and other unions, but it is now more widespread and even reported from deep in his own party, among cabinet colleagues. The public are bewildered and staff in the service doing a difficult job while debate rages and the...

I got an encouraging letter from the Secretary of State responding to our and The King’s Fund’s analysis on how integrated care could be developed in England. Our publication and other bits are a synthesis of what we know, with some concrete suggestions on how to move ahead.

There is now a tailwind, and the Department of Health, NHS Commissioning Board and Monitor are currently mulling over how best to respond. More on this in the spring.

Meantime, for those weary of Kaiser and Torbay as examples, The Commonwealth Fund this...