In my clinic last Friday I was shocked: four out of sixteen appointments were taken by patients who were unable to gain access to the hospital services they had been told they needed. Having each tried to contact the hospital several times, they came to me to ask for help in navigating hospital booking systems, for interim pain relief, and reassurance. GP appointments that should have been available for clinical problems were used for administrative support, alongside clinical advice on the symptoms that arose from delays in care.... Continue reading
31 Oct 2014
23 Oct 2014
It’s the report the NHS has been waiting for.
Simon Stevens’ vision for the future of how care will be organised and delivered in England is set out in the Five Year Forward View – the first time the arm’s length bodies in the NHS have come together to produce such a report.
Just as he did when creating The...Continue reading
6 Oct 2014
There has been a lot of concern expressed about the planned free trade deal between the European Union and the US, the Transatlantic Trade and Investment Partnership, and the impact it will have on the NHS.
TTIP seems to combine a number of popular demons in health circles: privatisation, US healthcare, competition and Europe. The fact that the Department for Business, Innovation and Skills is leading UK negotiations on behalf of the NHS might also make those who remember the Working Time Directive nervous.
So just how big a threat is TTIP to the way the NHS works? The...Continue reading
(Guest blogger)7 Aug 2014
The Health Secretary has quite a difficult job. He is charged with encouraging quality improvements in the NHS while it is, as the Nuffield Trust’s report Into the Red? shows, under considerable – perhaps unsustainable – financial pressure.Continue reading
6 Aug 2014
This week a study in the Lancet concluded that phone consultations with patients who request same-day appointments generate additional work for GPs when compared to face–to-face encounters. In some ways, the study provides further evidence for the existence of induced demand – the phenomenon that widening access for health care fuels use – that we highlighted in a recent Nuffield Trust report (June 2014).
If patients can’t have all of their care needs...Continue reading
4 Aug 2014
I'd heard over the weekend that Jeremy Hunt would make an announcement on NHS waiting times today. My sort of thing (see Buzzfeed for details). I was intrigued.
When I got up, I read this short teaser piece from the Health Service Journal. In a nutshell, Mr. Hunt was giving trusts space...Continue reading
11 Jul 2014
Yesterday our Into the Red? report revealed worrying signs about the future funding of the NHS in England. This was echoed in the results of our first survey of leading figures from the field of health and social care, with around half of respondents saying they felt it was unlikely that the NHS would be free at the point of use in ten years’ time.
But the NHS is only half the picture....Continue reading
10 Jul 2014
Our report, Into the red? The State of the NHS’ finances, sets out the facts on NHS expenditure between 2010 and 2014. It is clear on figures for 2013/14 from Monitor and The NHS Trust Development Authority, that, subject to audit, NHS providers will post a small overall deficit of £100 million. Equivalent figures from NHS England show that the commissioning side will produce a small surplus. The overall result for the entire NHS is likely to be happiness in Mr Micawber’s terms....Continue reading
(Guest blogger)19 Jun 2014
On June 9, I finished my ward round of 24 inpatients – median age 80-plus, legged it to the station and got into London just in time to set up my workshop on models of care for frail older people at the Nuffield Trust Future Hospitals conference.
At the event, I presented some challenging ‘home truths’ alongside an animation and some practical solutions.
The “home truths”
Sometimes, people who feel they are challenging orthodoxies end up...Continue reading
13 Jun 2014
NHS England Chief Executive Simon Stevens issued his challenge to rethink the role of the hospital in more imaginative ways after this week’s Nuffield Trust’s conference on the future of the hospital was already in the diary.
There were some clear lessons from our audience of hospital leaders – many on the theme that simple answers of hot-cold splits (separating emergency from elective care), centralisation, mergers etc are not working. I took away a number of lessons:
Decisions need to be made about where to focus: smaller hospitals...Continue reading
17 Apr 2014
Recently, on one of my clinical general practice days, I made 21 phone calls to a London hospital trying to leave a message asking a consultant to call me urgently. A patient I had seen at 9am had decided not to have a disfiguring operation for a cancer that was planned for 10 days later.
I needed urgent advice about the options for reconstructive surgery so that I could have an informed discussion with her during the following week about the choice she had made. Had she understood the facts about her condition? The consequences of refusing treatment? Time was of the essence: I...Continue reading
11 Apr 2014
Criticism of the Welsh NHS is a popular sport for English ministers. David Cameron takes regular pot shots at longer waiting times and failure to hit A&E targets.
To the politically cynical, it looks like a straightforward attempt to brand Labour, who governs in Wales, as a party that cannot manage the NHS.
It may also be an attempt to show that the ‘English’ approach to managing the NHS, with the development of a market, competition and a variety of private, voluntary and other providers, is producing better results than that in Wales which abolished...Continue reading
(Guest blogger)24 Mar 2014
Frontier Economics hosted a roundtable discussion at the recent Nuffield Trust Health Policy Summit to discuss the development of economic regulation.
We drew some (only some – yes, health care is different) inspiration from the experience of other regulators. The early days of Postcomm – the postal regulator overseeing a government-owned Royal Mail – provided some lessons.
Postcomm reached for the standard regulatory toolkit but found itself foiled by a publicly owned Royal Mail who accumulated losses year on year. Sound familiar? In the end the...Continue reading
19 Mar 2014
Today’s Budget contained no new announcements when it comes to health and social care. While the continuation of austerity beyond the next election will almost certainly mean more tough decisions on public spending in the next spending review, today was all about warming up to electorate for the election with eye-catching policies on tax and pensions.
The big news as far as the NHS is concerned had already been announced: last week the Government set out its decision on NHS pay over the next two years.
NHS staff in England who receive incremental pay award will not have any...Continue reading
(Guest blogger)14 Mar 2014
“It constantly surprises me that my colleagues don’t recognise the power of personal leadership”.
This is one of the quotes from a study of successful service reconfigurations. All across the economy leaders have to change services – often asking users to accept different modes of delivery for financial reasons. But across the NHS, some manage it well, whereas others effectively blow their toes off one by one with a shotgun.
Why? One is assuming that the public and colleagues are rational, and once they realise the basis of your sensible arguments, they will go along...Continue reading
(Guest blogger)20 Feb 2014
The NHS payment system defines the mechanisms through which NHS-funded care is paid for, and the prices paid. These mechanisms and prices are levers available to commissioners to incentivise providers to achieve health care objectives, such as better health outcomes, activity targets, greater efficiency, and reduced waiting times.
For example, the “Payment by Results” system, through which hospitals are paid according to how much treatment they provide, was introduced to incentivise more hospital activity, at a time of long and growing...Continue reading
(Guest blogger)18 Feb 2014
The Nuffield Trust report: The Francis Report: one year on states that hospitals have taken significant heed of Francis, and have focused in many and varied ways on care quality, compassion, complaints, nursing and openness and transparency.
(Guest blogger)6 Feb 2014
Four years ago I published a report laying bare the shocking care provided at Stafford Hospital. I heard of an elderly patient left naked in public view covered in faeces, of another who died because she not given insulin, of wards where elderly patients were not helped with food and drink, of an A&E where waiting times were fabricated.
Staff who raised genuine concerns were not listened to or respected, and...Continue reading
30 Jan 2014
The Care Bill seems to be passing through Parliament with barely a ripple. Except for Clause 118. This is the clause where the Government is taking the opportunity to ‘clarify’ the law surrounding the Trust Special Administrator’s powers to drag other trusts into the frame when considering what to do with a failing one.
It stems from the successful judicial review over the proposed closure of Lewisham Hospital’s A&E department as part of the Special Administrator’s plans to deal with the...Continue reading
(Guest blogger)29 Jan 2014
Hospitals across Europe are under pressure. They all tend to have business models which rely on growing income and payers that are increasingly trying to contain them.
Big questions are being asked about future strategy but there is surprisingly little public debate about this important part of the health system and there is insufficient policy analysis.Continue reading