Blog posts

Never in the field of NHS re-organisations can so many have left so few. Well, not literally. But April 1 sees some 160 NHS organisations, including all primary care trusts and strategic health authorities, abolished as hundreds more – 211 clinical commissioning groups plus a clutch of new national bodies and their regional arms – come formally into existence.

The result is what must be an unprecedented turnover of NHS chief executives. Some retiring, some moving on to other jobs, some taking redundancy, some leaving the direct employment of the service, some willingly, some not....

As clinical commissioning groups (CCGs) prepare for 1 April, one has to wonder how ready they really are to take full responsibility for local strategic planning and purchasing of health care.

The coming year will be one of immense challenge in terms of the quality and safety of health care, particularly in light of the Francis Inquiry’s call for a fundamental change in NHS culture.

And all of this at a time when NHS funding is flat and the NHS Commissioning...

The queasily thin amount of experienced medical cover in some hospitals at nights and weekends was the subject of BBC Radio 4's File on 4 last week. Juniors missing key symptoms and signs, not wanting to bother a consultant out of hours, with occasional tragic results or at best near misses.

Suggestions for remedy included making consultants work 24/7 rotas. I sympathised with the experienced paediatrician who predicted that would be the last straw for many who have given their all for the NHS over many years.

The...

The current exam question for commissioners charged with ensuring the sustainability of the NHS is 'how can we make sure the NHS delivers integrated and sustainable services?', or as patients and their carers are more likely to describe it – 'who will make sure that we get properly joined-up care that will meet our needs going forwards?'

Providing integrated or joined-up care is an important challenge. However, it is not the only challenge and if effective co-ordination of care is to play a major role in sustaining the NHS, commissioners will also have to...

Many GPs are wondering how to survive a future consisting of rising demand, revalidation, falling practice income, clinical commissioning group (CCG) scrutiny and more. Smaller practices in particular, with few staff, minimal infrastructure and tight budgets are struggling with the greater organisational, administrative and clinical demands.

Inevitably the question about how to increase the scale, resilience and quality of general practice comes up with increasing frequency. New Zealand, America and Holland all...

Telehealth is increasingly being advocated as a way to monitor patients remotely and better manage long-term health conditions. The Nuffield Trust was part of the largest randomised controlled trial in this area, “the Whole System Demonstrator” (WSD) – the initial results were published earlier in the summer.

We held a seminar with practitioners, researchers and funders to discuss the remaining research that needs to be done, post WSD. Priorities were identified as;...

“Integration…is like M&Ms…a thin, sugary veneer of medical ‘science’ over a yummy core of price fixing…” (US Healthcare Executive).

Over the last 12 months I’ve been researching the impact of competition policy on delivery system innovation and payment reforms that promote greater integration. My question has been: how might policy makers, regulators and health care leaders work constructively to produce an informed and proportionate competition regime applied to the NHS?

In the US, health care providers are united in the view that competition concerns – namely the fear of...

The first results of the largest randomised controlled trial on telehealth were published in the British Medical Journal last week. Of the five arms of the Department of Health-funded 'whole system demonstrator' (WSD) trial, the first (conducted by a team here at the Nuffield Trust) examined the impact on hospital admissions and costs.

The headline results so far: patients receiving telehealth care had just 0.14 fewer emergency admissions in the one year of follow up; and...

While changing demographics are putting considerable pressures on health and care systems in all Western countries, nowhere is it more acute than in Japan. A baby girl born today in Japan can expect to live to 86 and a baby boy to 79. By 2030, almost one in three people will be 65 or older.

Meeting the needs of an ageing population, against a backdrop of a diminishing total population, presents an enormous challenge for its Government. Yet Japan manages to provide universal health care coverage for its population (albeit with some co-payments) while spending around 8.5 per cent of...