The Nuffield Trust is dedicated to research on improving healthcare, our current projects are listed below.
NHS White Paper Equity and Excellence: liberating the NHS
The Coalition Government revealed its plans for reforming the NHS in England in the White Paper: Equity and Excellence: Liberating the NHS, published in July 2010. The White Paper outlines a number of key reforms that will deliver fundamental changes to the organisation and delivery of care to patients in the NHS in England. We have produced a briefing that examines the reforms in detail. This is one of a number of key resources that we will produce over the coming months as the White Paper moves through the legislative process.
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New Frontiers in NHS Efficiency
Project lead: Dr Judith Smith, Nuffield Trust
The NHS is facing one of the most significant financial challenges in its history. NHS Chief Executive David Nicholson has said that the NHS must look to save £15–20 billion by 2014. To help the NHS respond to this challenge, we are launching a major new programme of research and policy analysis that will examine how the service can become more efficient as it enters a period of significant financial restraint. The findings will be published in a series of reports in September 2010, culminating in a final report in spring 2011. We will also host a number of seminars to inform the programme. If you would like to receive regular updates on the programme and invitations to the seminars please click here to register your interest.
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Person-based Resource Allocation Project lead: Dr Jennifer Dixon, Nuffield Trust
The purpose of this project is to develop a robust resource allocation formula that could be used for allocations within PCTs to practice based commissioners that exploits linked person-level data and is genuinely predictive of costs in a future year. This project utilises all the main sources of data available, and links them where possible, to construct a new formula to help allocate resources for patient care. The project is now at an advanced stage and the Nuffield Trust will be writing up the findings in a final report, due to be published in summer 2010.
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Understanding trends in emergency care
Project leads: Ian Blunt, Martin Bardsley and Jennifer Dixon, Nuffield Trust
Emergency admissions now make up approximately 35 per cent of all hospital admissions in the NHS in England, at a cost of around £11 billion a year. Admitting a patient to hospital as an emergency case is costly and often avoidable, yet the number of emergency admissions to hospital has been rising for some time.
Using Hospital Episode Statistics, this project examines the possible reasons for the rise over a five year period from April 2004 to March 2009. The research explores trends in emergency care in relation to, for example: length of stay and hospital mortality rates; age and sex of patient, diagnosis and method of admission; and provider trust factors such as the impact of foundation status and other policy initiatives. The findings have been published in the report: Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency?, by Ian Blunt, Martin Bardsley and Jennifer Dixon. Further details
The future organisation and delivery of care
As the pressure increases to improve efficiency and enhance quality, NHS managers and clinicians are starting to look at new ways of organising and delivering care. The concept of integrated care has been emphasised as a means to achieve better care for patients. The premise of integrated care is that it will not only help to improve the coordination of care for patients and therefore prevent avoidable ill health, but also that it will result in greater value for money. While the formal evidence underpinning this premise is as yet underdeveloped, the wide variations in avoidable use of hospital care, in particular, suggest the scope for large gains in efficiency and health. A major part of our work programme is examining the potential of new forms of care. As part of this, we are publishing a number of reports and holding events to explore this theme in detail.
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Funding and performance of healthcare systems in the four countries of the UK Project leads: Professor Nick Mays, LSHTM, Professor Gwyn Bevan, LSE, and Sheelah Connolly, Queen's University Belfast
The health services of England, Scotland, Wales and Northern Ireland are all funded by the UK taxpayer, but since political devolution in 1999 they have developed different systems of governance and different policies. This project examines the impact of these changes by studying key performance indicators for the NHS in the four UK countries at three time points – 1996/7, 2002/3 and 2006/7. The findings are published in the report: Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution, by Sheelah Connolly, Nicholas Mays and Gwyn Bevan. This unique analysis compares NHS performance across the 10 English regions with the health services of the devolved countries – the first time such an analysis has been conducted. The report will be followed up by a separate study by the same authors that will examine how healthcare resources could be allocated more effectively across the UK. Further details
Examining the effectiveness of Virtual Wards
Project lead: Geraint Lewis, Senior Fellow, Nuffield Trust
The Nuffield Trust is to evaluate the costs and benefits to health and social care of Virtual Wards in Croydon, Devon and Wandsworth, with funding from the National Institute for Health Research (NIHR). This research, which will report in November 2011, aims to find out exactly how much it costs to run a Virtual Ward, and what effect (if any) they have on the use of health and social care services. It will be used to help councils and the NHS decide whether to fund Virtual Wards and how best to run them locally.
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Predicting Future Costs of Social Care
Project lead: Dr Martin Bardsley, Nuffield Trust This project, funded by the Department of Health, will test the feasibility of developing a statistical model to predict which individuals are most likely to incur social care costs payable by local authorities.
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Analyses of Ambulatory Care-Sensitive Conditions
When patients are admitted to hospital for treatment of an Ambulatory Care-Sensitive (ACS) condition, which is an acute, episodic or chronic illness or condition that can typically be treated in settings other than a hospital bed, this is regarded as an avoidable hospital admission. Rates of ACS admissions are used as a measure of the quality of primary care in a local area. By examining hospital admission rates for ACS conditions over the last nine years in district council areas of England, this project will outline the impact different policy initiatives, such as service reconfigurations, the GP contract and the introduction of practice-based commissioning, have had on ACS admissions. A final report will be published in summer 2010.
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Beyond Practice-based Commissioning Project leads: Dr Judith Smith, Nuffield Trust and Julie Wood, NHS Alliance
Practice-based commissioning (PbC) has been a cornerstone of the government’s health service reforms in England since it was introduced in 2005. However, it has so far had limited success in engaging GPs in decisions about the planning, funding and development of local health services. With the future of PbC in the balance, the Nuffield Trust and NHS Alliance set up a joint project to explore how clinical collectives or physician groups might evolve in the NHS as a more effective way of engaging GPs and other health professionals in decisions about how NHS money is spent. The Nuffield Trust and NHS Alliance published a report of their findings from this project on 23 November 2009.
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In Pursuit of Fairness
Project lead: Dr Jennifer Dixon, Nuffield Trust
With healthcare resources under pressure along with the rest of the public purse, and with innovative new statistical methods opening up the possibility of more sophisticated and personalized budgeting, this new Nuffield Trust work stream groups together several projects that aim to inform the debate on policy development in this area.
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Partnership for Older People: Evaluation of impact on emergency hospital use
The Partnership for Older People Projects (POPPs) were established by the Department of Health in 2005. Their aim is to encourage local councils to work in partnership with the NHS and with voluntary, community and independent organisations in order to improve the health, wellbeing and independence of older people. In addition to a national evaluation of the pilots, the Nuffield Trust was commissioned by DH to conduct a supplementary evaluation to examine in detail what effect the POPPs have had on rates of unplanned admission to hospital. The Nuffield Trust will publish the findings from its evaluation in autumn 2010.
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National Evaluation of Integrated Care Pilots: Using risk prediction methods to assess the impact of integrated care on service use
In 2009 the Department of Health launched a pilot programme to test and evaluate a range of models of integrated care. Each of the integrated care pilots is designed to explore different ways in which health and social care could be provided more seamlessly so that the health and well-being of individuals is improved. The Nuffield Trust will be supporting Ernst & Young and RAND Europe in an evaluation of the integrated care pilots, using an innovative method that links pseudonymous patient records over time. We will be exploiting existing, operational data to monitor the effect of the integrated care pilots on health and social care use. In particular, we shall be adjusting for the types of patients seen by the pilots. The Nuffield Trust will publish the findings from its evaluation in late 2011.
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Evaluation of the Whole System Demonstrator Project
Project lead: Professor Stan Newman, UCL
This research is part of a large randomised controlled trial and aims to track the impact of telecare and telehealth devices on the use and costs of NHS and social care and the return on investment. This 2-year trial funded by the Department of Health involves 6000 cases and controls.
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last updated 09/08/10