My heart sank when we got a glimpse of Labour’s thinking about post-election health policy, with hints that hospitals would be expected to evolve into integrated care organisations providing all health and...Continue reading
1 Oct 2014
25 Sep 2014
Our health services are not just about our health. They are also heavily involved in our deaths.
This year, for every 1,000 people in England, nine will die. Eight of those nine will have some hospital care during their final year of life. For four or five, a hospital bed will be their last.
Unsurprisingly, people who are near to the end of their lives are disproportionately high users of hospital services. We estimate, that approximately 15% of all emergency hospital admissions in England belong to the 1% of people in their final year of life.
We know that very many...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
(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 becoming the...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
4 Jun 2014
The response to NHS England Chief Executive Simon Stevens’ first interview says as much about the challenges facing the NHS as the content of the interviews themselves.
Mr Stevens’ message – to be pragmatic, to decide what’s right locally, to be bold, and to look beyond current bricks-and-mortar configurations – quickly transmuted under the media spotlight into one of harking back to a bygone age of cottage hospitals.
(Guest blogger)2 Jun 2014
A recently published Nuffield trust report offers a fascinating insight into the routes that cancer patients take through the care system. In an era that promotes integrated care we all accept that caring for a person extends beyond one organisation; and treatment for cancer may include primary, community and social care on top of acute hospital activities.
However, it is notoriously difficult to see what services patients are using as our information systems are usually so disjointed. Yet as this report shows it is now possible to...Continue reading
30 May 2014
As the noise generated by last week’s local and European elections fades, political energy will now be directed towards defining the policy battlegrounds on which next year’s General Election will be fought, which will have to be much wider than immigration and the European Union.
Even though the NHS is so central to politics in the United Kingdom, predicting how noisy an issue it will be in the run up to next year’s General Election is difficult. This is partly because of its peculiar status, at least in the minds of politicians, who believe that the voting public has an essentially...Continue reading
8 May 2014
Yesterday's Guardian reports that the Government’s plans for the Better Care Fund have been put on hold as the Cabinet Office demand that the Department of Health do more to explain how the savings needed to pay for it will be secured. Government sources have been quick to dampen speculation that this signals trouble for the plans.
But the question reportedly asked by the Cabinet Office is exactly the right one, albeit at an odd time, as the Bill to set up the Fund is...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
17 Jan 2014
Most of the services we receive nowadays (be it internet shopping, high street banking or health care) have a trail of data associated with them. We’ve come to expect that these trails will be used to help future interactions be more efficient for us and/or those providing the service.
This applies as much to public as private sector services – though we’ve also come to expect that the public sector lags well behind the private sector when it comes to IT matters.
In many cases this perception of the public sector is probably true (any luck making a GP appointment online...Continue reading
9 Jan 2014
The BBC’s research, published yesterday, on frequent users of A&E makes for interesting reading. They found that nearly 12,000 people made more than 10 visits to the same unit in 2012/13, and a small number of those attended more than 50 times. This is an eye catching finding and it is important to consider what those numbers might actually mean.
While the 200,000 attendances used by people attending A&E more than 10 times a year is a big number, it represents just a tiny fraction of the 14 million total attendances at...Continue reading
6 Nov 2013
Implementing new models of care is not easy – and especially so when organising community-based services that aim to tackle the challenges of more chronic disease and greater levels of emergency care.
One of the more interesting approaches of the past few years has been the Virtual Ward and we recently published a report, funded by the National Institute for Health Research Service Delivery and Organisation Programme, looking at three early examples of Virtual...Continue reading
5 Nov 2013
All too often in discussion of the NHS, pharmacy is seen as something of a niche concern. General practitioners, consultants, nurses and even managers loom large in parliamentary debates on the future of health care, in newspaper articles and the public mind.
Pharmacists, meanwhile, punch well below their weight in policy and management circles despite being the third largest health care profession.
The innovative, often inspiring services I saw as chair of the Royal Pharmaceutical Society’s...Continue reading
12 Aug 2013
Today we publish our response to the Care Quality Commission’s (CQC) consultation on changes to the way it inspects, regulates and monitors care services: A New Start.
Our response builds on the findings from our review of provider ratings, commissioned by the Secretary of State for Health, as well as drawing on the expertise of various members of our team with a past in regulation.
18 Jul 2013
Looking back over recent blogs about primary care written by Jonathan Tomlinson, Clare Gerada, John Macaskill-Smith and Helen Parker, three things stand out.
First, there is consensus that general practice is under significant pressure, struggling to meet demand from patients, blamed for contributing to the alleged crisis in accident and emergency care, and exhorted to reassume responsibility for out-of-hours patient care.
Second, the ‘special sauce’ of general practice – the relationship between a patient and their family...Continue reading
26 Jun 2013
Over the past four years the Nuffield Trust have been asked to look at a range of service innovations and assess whether they lead to a change in service use – most typically a reduction in inpatient hospital activity, which is something that seems to have become the holy grail of health service planning.
Our new report summarises observations from our studies and efforts that might help those planning and evaluating new services in the future. In particular, the report should provide useful learning for the new...Continue reading
(Guest blogger)24 Jun 2013
Clinicians and health service administrators can often identify ways of reconfiguring services, particularly hospital services. These reconfigurations usually appear to deliver improved outcomes but prove hard to sell to a sceptical public. On these occasions, local politicians are urged to be brave and support such moves.
All too often though, the politician is found fanning the flames of popular discontent and those inside the NHS look upon them with varying degrees of sympathy, bewilderment, despair or contempt. The situation is actually made worse if health insiders believe that...Continue reading
30 May 2013
A week after the Government's integrated care pioneer programme kicked off, the evaluation of North West London's integrated care pilot was published. The ingredients of the pilot were sensible, for example: investment in IT, risk stratification and targeting of high risk patients, leadership, coordination of multidisciplinary groups, and project management.
The results so far: high commitment by professionals; greater collaborative working across teams and with social...Continue reading
23 May 2013
General practice seems to be considered by politicians and the media as both the cause of and solution to the current crisis in demand for urgent and emergency care.
At the same time, the primary care community is recognising that the current business model of general practice is under threat due to increased demand by patients, growing regulatory workload and, for some this year, significantly less income.
From discussions with GPs and policy makers, there appears to be some consensus that the current ‘small scale’...Continue reading