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

    13 Feb 2015
    Comments

    This blog is the third in a new series called ‘Fact or fiction?’, where experts from the Nuffield Trust give their take on the data and evidence behind some of the current perceptions of what is happening with the NHS.

    Views on targets are highly polarised. Special interest groups are keen to get a target for their priority area while detractors question their clinical validity and assert that care has become 'all about meeting targets'; a sense of achievement abstracted from meaning. Yet in the past targets have been associated with dramatic improvements in...

    Continue reading
  2. Mortality rates: getting the right measure

    13 Feb 2015
    Comments

    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. The purpose of this is to identify how many deaths could have been avoided through better care quality – and presumably find ways to identify and implement change where care falls below standard. 

    Although we hope that hospital care improves our chances of survival, we also know that simply counting deaths is misleading. For me there are three underlying issues:

    1. Why not use the...
    Continue reading
  3. 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. His argument was that this relaxation would give hospitals breathing space to treat people who’ve been waiting the longest (over 52 weeks). They had until December 2014 to sort it out.

    At the time the...

    Continue reading
  4. The Cancer Drugs Fund: An important stopgap

    (Guest blogger)
    14 Jan 2015
    Comments

    Yesterday, as part of their blog series on the Cancer Drugs Fund, the Nuffield Trust posted a blog from Health Policy Fellow, Helen Crump, outlining some of the difficult questions surrounding the Fund. 

    The Cancer Drugs Fund clearly isn’t perfect – as Helen points out, it creates a perverse incentive for drug companies not to reduce prices – but it’s far better than what we had before. At a time when the CDF is under...

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

    (Guest blogger)
    14 Jan 2015
    Comments

    As demonstrated in Helen Crump's recent blog for the Nuffield Trust, the debate around both the merits and future of the Cancer Drugs Fund (CDF) has reached fever pitch over the last month or so following the announcement that drugs not deemed to be of value for money were to be delisted. I do not think anyone should be surprised or shocked about this – it was just a matter of time before this car...

    Continue reading
  6. 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.

    In the coming days, guest bloggers from two cancer charities, Macmillan Cancer Support and Myeloma UK, will be sharing their views about the fund and its future....

    Continue reading
  7. 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...

    Continue reading
  8. 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.

    I believe a crisis is imminent, if not already upon us. One local GP practice has...

    Continue reading
  9. 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.

    What makes perfect sense as a solution for one provider can seem utterly implausible or...

    Continue reading
  10. 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.

    ... Continue reading
  11. 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. 

    Just as he did when creating The...

    Continue reading
  12. 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? The...

    Continue reading
  13. More NHS charges? Lessons from history

    (Guest blogger)
    7 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.

    As the new two-part edition of my book on the history of the health service From Cradle to Grave, or the Nuffield Trust’s interactive timeline show; providing a high-quality,...

    Continue reading
  14. 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).

    If patients can’t have all of their care needs...

    Continue reading
  15. 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.

    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
  16. 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.

    But the NHS is only half the picture....

    Continue reading
  17. Financial Crystal Ball Gazing

    10 Jul 2014
    Comments

    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
  18. 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.

    The “home truths”

    Sometimes, people who feel they are challenging orthodoxies end up...

    Continue reading
  19. The future of the hospital: some useful lessons

    13 Jun 2014
    Comments

    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
  20. The nitty gritty detail of integrating complex systems

    17 Apr 2014
    Comments

    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

Email to a friend

Your message will be:

I thought you might be interested in this page on The Nuffield Trust website.