1. The view from local government: Reconsidering accountability in an age of integrated care

    (Guest blogger)
    20 Jul 2015
    Comments

    There is cross-party consensus both within the Local Government Association and nationally that integration of health and social care is the right approach, particularly for improving outcomes for citizens, but also for improving value for money in the long term. But how this move towards integration works in practice is up for debate, as mentioned in Ben Jupp's viewpoint paper recently published by the Nuffield Trust.

    Jeremy Hunt is clear that a strong NHS depends on a strong...

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  2. The view from commissioners: Reconsidering accountability in an age of integrated care

    (Guest blogger)
    17 Jul 2015
    Comments

    Steve Kell, Co-Chair of NHS Clinical Commissioners, argues that concerns that conflicts of interest between GPs as commissioners and GPs as providers of care would hinder decision making have so far proved unfounded. CCGs and their governing bodies are recognising where conflicts of interest might arise and are managing them, rather than seeing them as a barrier to commissioning high-quality care in a local context.

    Therefore, he argues that we already have the structures in place to deliver improvements to population health and that we should focus first on improving health...

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  3. The view from Healthwatch: Reconsidering accountability in an age of integrated care

    (Guest blogger)
    16 Jul 2015
    Comments

    Responding to Ben Jupp's paper 'Reconsidering accountability in an age of integrated care', Jan Sensier argues that the most important factor for real accountability in the face of changing services is the voice of the public and patient.

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  4. The view from Westminster: Reconsidering accountability in an age of integrated care

    (Guest blogger)
    15 Jul 2015
    Comments

    All too often, discussions about accountability focus on structures and processes, emphasising the importance of reconciling different interests. All of that is important, but it is in danger of confusing method with purpose, argues Stephen Dorrell in a blog responding to a recent paper by Ben Jupp.

    He adds that accountability structures don’t exist to justify the status quo – they exist to facilitate change. Measured against that test, Ben is right to question whether current commissioning structures are fit for purpose. 

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  5. How can England’s experience of integrated care help Finland?

    9 Jul 2015
    Comments

    Rapidly merging municipalities in Finland have led to budget fragmentation of health budgets and accountability, but there is a desire for greater integration. A delegation from Finland recently visited the Nuffield Trust to listen to representatives from pioneer and early adopter sites, academics and NHS England officials describe the challenges that the Finns might face as they begin to integrate health and social care services.

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  6. 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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  7. What’s behind the drop in A&E performance?

    9 Jan 2015
    Comments

    Earlier this week there was a sense of panic in the air as a number of hospitals declared ‘major incidents’ and missed their waiting time targets. It’s a response somewhat out of proportion to the scale of the problem – while performance is among the worst it has been in the last decade, it’s still high by international and longer-term historical standards.

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  8. Pharmacists as care givers can make the forward view come true

    17 Dec 2014
    Comments

    Listening to reaction to the chancellor’s Autumn Statement on 3 December, anyone would think that Simon Stevens’ NHS Five Year Forward View was no more than a clearly made case for more money for the NHS.

    But the cornerstone of the forward view is the new models of care that will unlock change in the NHS: from GP networks becoming large scale community services providers, to district general hospitals as hubs of new accountable care organisations.

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  9. 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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  10. 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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  11. If only we could focus on the end rather than the means

    1 Oct 2014
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    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...

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  12. Counting the cost of end of life care

    25 Sep 2014
    Comments

    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.

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  13. 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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  14. 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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  15. 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. 

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  16. Local leaders unleashed? What to expect from Simon Stevens’ reign

    4 Jun 2014
    Comments

    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...

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  17. Social care and cancer: tracking care across service boundaries

    (Guest blogger)
    2 Jun 2014
    Comments

    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.

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  18. NHS and social care funding: speaking truth to piety

    30 May 2014
    Comments

    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.

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  19. The Better Care Fund: do the sums add up?

    8 May 2014
    Comments

    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.

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  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.

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