1. 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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  2. 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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  3. Fact or Fiction? Targets improve quality in the NHS

    13 Feb 2015
    Comments

    Views on targets are highly polarised, and recently there has been much anguish and headlines that the NHS is "dying" and "third world". But are targets good or bad for the NHS? Ian Blunt looks at the facts. 

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  4. Mortality rates: getting the right measure

    13 Feb 2015
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    The Secretary of State has recently announced an annual review of the case notes of 2,000 people who have died in hospital every year. Chris Sherlaw-Johnson examines the problems with this approach. 

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  5. The tail of the long waiters

    16 Jan 2015
    Comments

    In August, Jeremy Hunt announced a ‘managed breach’ of two shorter-term (18 week) treatment waiting time targets: the expectation that 90% of inpatient and 95% of outpatient treatments started within 18 weeks of referral. But did it pay off? 

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  6. 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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  7. 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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  8. 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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  9. 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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  10. 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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  11. 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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  12. 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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  13. 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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  14. Those worrying about the transatlantic trade deal should look closer to home

    6 Oct 2014
    Comments

    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?

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  15. More NHS charges? Lessons from history

    (Guest blogger)
    8 Aug 2014
    Comments

    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.

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  16. The ‘wicked’ problem of access: is the telephone a solution?

    6 Aug 2014
    Comments

    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).

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  17. A good idea? Wait and see

    4 Aug 2014
    Comments

    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.

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  18. Only half the picture: understanding the impact of the social care squeeze

    11 Jul 2014
    Comments

    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.

     

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  19. Financial Crystal Ball Gazing

    10 Jul 2014
    Comments

    Our report, Into the red? The State of the NHS’ financessets 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.

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  20. Making hospitals fit for the frail older people who actually use them

    (Guest blogger)
    19 Jun 2014
    Comments

    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.

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