1. Prudent progress in the Welsh NHS

    (Guest blogger)
    29 Jul 2015
    Comments

    What’s Wales’ approach to the NHS? What drives painful change west of Offa’s Dyke? That famous Scot, Adam Smith, has no legacy here. Markets have gone from Welsh healthcare, and will probably never return given the predominance of left-of-centre politics. Similarly, we have eschewed a simple command-and-control where ministers and their civil servants make appointments and decisions across Wales directly. Yet there will be a temptation for future Health Ministers to revert to this in their frustration at the slow pace of development. Because the most common criticism of the NHS in Wales,...

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  2. Facing future challenges: do changes in skill mix offer some solutions?

    25 Jun 2015
    Comments

    Candace Imison explores whether changes in skill mix offers some solutions to the challenges faced across the spectrum of the NHS. 

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  3. Time for tough decisions: Northern Ireland’s great health challenge

    (Guest blogger)
    23 Jun 2015
    Comments

    Hugh McCaughey, Chief Executive of the South Eastern Health and Social Care Trust in Northern Ireland blogs about the great health challenges facing the country, and examines the options. 

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  4. NHS agency staff costs: treating the symptom not the cause

    9 Jun 2015
    Comments

    Candace Imison explores the Secretary of State for Health's recent campaign against agency staff costs and considers whether this approach might well be treating the symptom, but not the cause. 

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  5. The NHS bidding war

    21 Apr 2015
    Comments

    Last week, all the major parties in England laid out their bids to be trusted with the future of the NHS. The bids were partly denominated in hard cash as each pledged higher spending. But observers could be forgiven for still having quite a few questions.

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  6. Health spending across the UK nations: Who decides how much?

    10 Apr 2015
    Comments

    What is the truth about where decisions in funding are taken, and what difference could the election make? Mark Dayan looks at the facts. 

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  7. Fact or Fiction? Reconfiguring hospital services will deliver significant savings

    25 Mar 2015
    Comments

    NHS hospitals are under mounting financial pressure. A common belief is that the reconfiguration of hospital services, primarily through rationalising services across sites and shifting services into the community will help resolve these pressures.

    But how realistic is this belief? What does the evidence tell us?

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  8. The way the NHS manages A&E problems is not fit for purpose

    6 Mar 2015
    Comments

    In researching the recent problems in accident and emergency performance, I was struck by the way the NHS is managing the situation: there appears to be a large amount of activity across the system – conference calls, emails, phones calls – to check progress and request detailed information. Is this adding value or causing problems? And why is this type of activity thought to be an important part of the response? 

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  9. Fact or fiction? Demand for GP appointments is driving the ‘crisis’ in general practice

    3 Mar 2015
    Comments

    Headlines and stories about the ‘crisis’ in general practice have become commonplace over the last year or so. A demoralised and squeezed workforce is struggling to meet the needs of increasing numbers of patients demanding immediate appointments. Or so the narrative goes.

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  10. MPs will always be part of the rationing equation

    (Guest blogger)
    18 Feb 2015
    Comments

    Most people can accept that, in any cash-limited system, there will be some things that cannot be funded. However, translating this relatively simple, if abstract, concept into a practical and defensible process is challenging.

    Rationing is probably not a very helpful term to describe the difficult decisions health services face about potentially denying people care that their doctors think they need. In the UK when we think of rationing we tend to think of the World Wars.

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  11. Rationing: An unhelpful term for the broader issue of prioritisation

    (Guest blogger)
    18 Feb 2015
    Comments

    Clinical commissioning places general practitioners at the heart of local health planning. As clinicians, we want to ensure that we provide every service our patients want, and that every health intervention comes with the necessary aftercare and support. There are, however, two important additional factors.

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  12. The Cancer Drugs Fund: An important stopgap

    (Guest blogger)
    14 Jan 2015
    Comments

     At a time when the CDF is under the public spotlight, it’s useful to remind ourselves about the problems that the Fund was set up to address, and recognise that while it is by no means the finished article, it has gone some way to plugging a gap. 

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  13. We are in a hole with the Cancer Drugs Fund – why do we keep on digging?

    (Guest blogger)
    14 Jan 2015
    Comments

    The news that the Fund was to be extended into 2016 brought equal amounts of delight and concern. The proponents of the Fund, who had hailed its introduction, were delighted, however, it raised huge concerns for those that could see its obvious flaws.

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  14. The Cancer Drugs Fund: a question of value(s)

    13 Jan 2015
    Comments

    NHS England’s announcement yesterday on the future of the Cancer Drugs Fund has reignited an important debate about how to understand ‘value’ in relation to NHS services. This blog provides an overview of the issues, and suggests what we at the Nuffield Trust think is a good way forward.

     

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  15. America’s primary care revolutionaries

    (Guest blogger)
    16 Dec 2014
    Comments

    A new breed of healthcare provider is subverting the model of American healthcare for its most needy patients, whilst improving care and reducing costs.

    Need a lift to the doctor? If you’re a patient of CareMore in the American southwest, they may well chauffeur you there. Worried about falling over in your sitting room? They’ll fit you a new carpet. Not sure when to pop your next pill? Don’t worry – your medicine box will sing you a tune when the time comes.

    Casual observers might...

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  16. How pharmacy could save the NHS

    (Guest blogger)
    9 Dec 2014
    Comments

    I read Amit Bhargava’s recent blog with interest – among many other pieces on the financial pressures facing the NHS, and the recruitment pressures facing GPs. The one that affected me most was a blog by a female GP who faced burning-out under the stress of it all and ended up with a silent breakdown.

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  17. Beyond the blueprint: are bespoke solutions the future of the NHS?

    5 Dec 2014
    Comments

    It is obvious to the point of cliché that NHS providers are experiencing challenging times. But while some are struggling, others are faring better in this difficult climate.

    Although similar problems (decreasing tariff levels, costly private finance initiative contracts and recruitment challenges to name a few) affect multiple providers, the consequences providers experience will vary depending on factors such as the state of the local health economy, and the shape of the organisation.

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  18. Three key factors for making NHS England’s Forward View a success on the frontline

    31 Oct 2014
    Comments

    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.

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  19. Over-stretched hospitals: let's improve how patients are met on arrival, not block the front door.

    (Guest blogger)
    30 Oct 2014
    Comments

    Jeremy Hunt this morning pledged that £5bn worth of Better Care Fund allocations, founded on targets for reducing urgent hospital admissions, will 'change the basic NHS model'.

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  20. Local leaders and MPs must embrace NHS England vision

    23 Oct 2014
    Comments

    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. 

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