All too often in discussion of the NHS, pharmacy is seen as something of a niche concern. General practitioners, consultants, nurses and even managers loom large in parliamentary debates on the future of health care, in newspaper articles and the public mind.
Pharmacists, meanwhile, punch well below their weight in policy and management circles despite being the third largest health care profession.
In the old days at the start of this century, the Chief Executive of the NHS was the man in charge, clearly accountable for NHS success or failure at national and local level.
True, politicians occasionally ‘interfered’, as well they might given their direct accountability to Parliament and the electorate. Some did so more than others. Alan Milburn famously filled all the executive positions from CEO to HR Director. His writ ran to the operation of a hospital morgue in Bedford.
This may not have been the best way to run the service – it certainly had its limitations and faults...
The report identifies the work CCGs do in relation to engaging stakeholders as being critical. Involving clinicians, patients and the public in service redesign work has become fairly routine as CCGs try to reach their...
The quality of NHS care has been scrutinised in the past year probably more than in any other since its birth. We are contributing to this debate by launching QualityWatch – a programme to look at how quality of care in England is changing.
The past two years have seen a series of reports detailing high-profile failures of care or concerns about other potential ones. It is clear that assessing quality is of increasing importance to an increasing number of organisations, both...
Since the money stopped flowing freely into the NHS, there has been a relentless focus on the hospital. Recent concerns about quality are matched by continuing concern about money.
They come together in the increasing professional and managerial clamour for reconfiguration as the solution to quality and financial issues, targeting smaller hospitals in the way stranded explorers might look hungrily at their weakest comrade.
Approximately £40billion of total NHS expenditure in 2011/12 was spent on local contracts for services that do not have nationally mandated prices. Until now little research has been done to assess just how effective these have been in delivering more for patients, with the focus being on national price setting.
It has been very well advertised that the Health and Social Care Act 2012 places GPs more at the centre of the health care landscape. That was the explicit intention of the Government. GPs have always combined a vital clinical role with a (related) role of gate-keeper into the wider health care system.
The Act has given them an even more prominent role by handing a large proportion of the budget for health care spending over to clinical commissioning groups (CCGs) which GPs run. The importance of GPs in how health care evolves was emphasised by the importance...
As a health service historian I am fascinated by the ‘big ideas’ that colour thinking about our health service system. The first is that of the ‘system’ itself, the way in which over 200 years hospitals have progressively given up rugged independence to act as...
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...
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.
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.
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.
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.
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.
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.
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...