UK & international comparisons

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...

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,...

We’re all familiar with the challenges facing the NHS: the tightening budgets, the ageing population, the rising tide of chronic disease and how we organise services to provide a coordinated and seamless experience for complex patients.  What is perhaps comforting is that we are not alone.

At a recent conference, the Canadian Health Services Research Foundation (CHSRF) brought together 150 chief executives of various health providers from across the country to discuss these exact issues.  They were kind enough to...

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...

Data from countries within the Organisation for Economic Co-operation and Development (OECD) shows a roughly inverse correlation between spending on health (as a share of GDP) and mortality, and a roughly inverse correlation between growth in spending on health and improvements in mortality (the correlations hold even if the US is excluded).

These glaring facts are likely to force ever more attention on health productivity, health innovation and the adoption of models from elsewhere that can demonstrably...

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...

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...

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...

A key challenge for NHS commissioning is to develop a ‘golden thread’ between commissioning decisions and changes in the behaviour of front-line professionals.

Over the years, we have found many ways to achieve this at the margins, for example through commissioning additional services, creating financial incentives or leading service redesign initiatives. But we have not yet found a way to weave that golden thread through the whole health and care system.

In her recent presentation at a...

What will 2012 hold for health care? Let’s ignore for now the inevitable political controversy and ideological teeth-grinding over health reform that will no doubt continue on both sides of the Atlantic.

If we focus instead on the payment and delivery system reforms that will preoccupy the health sector, then the concept of integrated care is likely to be somewhere near the top of the list (again).

Here, in the US, this means 2012 will be the year of the ACO – ‘the accountable care organisation’ – widely regarded as a cornerstone of the current reform agenda. The past...

OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

Alan brings together his long experience of analysis in the US, and his...

I have been in Boston for a few months now, and the weather has turned.  We were robbed of a spectacular New England Fall. Some blamed the hurricane; some the earthquake; the more scientific amongst us, the temperature.

Fall was delayed as the chlorophyll rich leaves persisted due to the stimulation of an atypically warm and sunny October/November. After weeks of patiently waiting for the leaves to change colour, they changed abruptly and fell almost without anyone noticing.

Around the same time, Don Berwick was quietly making ready his notes for his successor as he was...

Earlier this autumn, I had the opportunity to visit the Hospital2Home virtual ward project in New York. Like other virtual wards, this project aims to reduce the risk of unplanned hospital admission for people at high predicted risk of admission. 

I was particularly interested to visit this project because it has strong partnerships with health care, social care and charitable organisations, and it cares for some of the most vulnerable people in...

I’m only a couple of months into my year in the USA.

Breakfast with Lansley. Lunch with Berwick.  A chance meeting with Obama (Michelle, not Barack). And dinners with more top-rate health care academics, analysts and policy-makers from around the world than would have seemed possible just a few short weeks ago.

With this has come slides – lots of slides. Slides showing how bad things are here. Slides showing how good things are there. Slides showing how Japan is doing its best to make everyone look average, and slides showing how India plans to break the mould in eye-...

‘Integration, integration, integration’ may not yet be on Channel 4 at 8pm on a Wednesday night but it is right up there on the agenda of the NHS.  It’s a central theme of the Health and Social Care Bill; it’s one of the key areas for the Future Forum’s second listening exercise; and perhaps, to quote Chris Ham, “it’s an idea whose time has come.”

Our involvement with the Nuffield Trust, participation in the listening exercise and in the newly convened ‘Integrated Care Discovery Community’ here in the northwest, has given us...

I recently had the opportunity to visit the Toronto virtual ward as part of my Management Fellowship role working with researchers at the Nuffield Trust who are evaluating the costs and benefits of the virtual wards in Croydon, Devon and Wandsworth.

The virtual wards work just like hospital wards, using the same staffing, systems and daily routines, except that the people being cared for stay in their own homes throughout.

The purpose of...

In September, Andrew Lansley accepted the Independent Reconfiguration Panel’s recommendations to proceed with changes to services at Chase Farm hospital in North London. These changes continue to be very unpopular locally, but as the Secretary of State’s statement acknowledged, these were hard choices about the safety and sustainability of services. And then he added: “This is not about money. We are not making cuts to local services.”

Whether or not local campaigners agree, this statement...