Healthcare has continued to dominate the news and public policy agenda throughout 2014. From the growing sense of crisis in general practice to mounting concerns about the solvency of NHS organisations, the NHS and social care look set to dominate the 2015 General Election.
And as Simon Steven’s Five Year Forward View continues to play a central role in framing the future direction of health policy, it seems apt for the Nuffield Trust to take a look back at the year in review – let’s call it the Nuffield Trust’s One Year Backward Look.
2014 started with considerable debate about care.data, where data from GP practices would be collated and linked to hospital records on a national scale for the first time. The controversy prompted us to join The King’s Fund and Health Foundation in writing to the Telegraph welcoming the principle of data linkage. On the same day, senior analyst Ian Blunt wrote a popular blog examining the case for such data linkage. It also led to us responding to a government consultation on the matter later in the year.
February saw the first anniversary of the publication of the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (the Francis Inquiry). To mark the occasion we published new analysis looking at how hospitals had responded to the inquiry, revealing worrying signs that financial pressures were making it hard for hospitals to create the patient-centred culture Robert Francis recommended. Our research was launched at an event in London and was welcomed by many national bodies and covered widely in the national media, including through a comment piece in The Times written by Robert Francis.
The Chancellor’s Budget in March confirmed further spending cuts to most non-protected departments, including to local government budgets. Our QualityWatch programme with the Health Foundation explored the impact of local government cuts on adult social care, revealing that over a quarter of a million fewer people were receiving publicly funded social care since 2010. The analysis was featured on the front page of the Guardian and was welcomed by MPs, organisations working in health and social care, and front-line staff alike.
Simon Stevens wasn’t the only new Chief Executive starting work in April. Our new Chief Executive Nigel Edwards began work on the same day, with a vision to connect innovative practice with policy. And as political attention began to focus on the Scottish referendum and the political heat started to turn up on the Welsh NHS, our analysis of the performance of the NHS in the four countries of the UK brought some much-needed facts to the debate. We revealed significant performance improvement across the countries, but worrying signs over lengthening waiting times in Wales.
The Government’s shakeup of the funding of social care culminated in May as the Care Bill received Royal Assent. Our briefings and analysis were key to informing the development of this legislation, receiving several mentions in parliament as the Bill progressed. May also saw us launch new analysis on antidepressant prescribing as part of the QualityWatch Programme, which revealed worrying variation in prescribing rates across the country.
As Simon Stevens made the headlines with his views on small hospitals, our day-long seminar brought together chief executives and front-line works from across the NHS to debate the future of the small hospital. Nigel Edwards’s blog on the topic became a widely used resource for people within and outside of the NHS seeking to understand examples of innovative practice, and the event sparked a stream of work that would culminate in the founding of the New Cavendish Group.
As the NHS continued to deal with growing demand for hospital services, concern began to mount over solvency of NHS provider organisations. Our Into the Red analysis warned of a possible funding crisis before the General Election, and was covered extensively in the media, including on the BBC, Financial Times, The Guardian, The Times and on Channel 4 News. The analysis added to a growing body of evidence making the case for further funding for the NHS in 2015/16, which was announced at the Autumn Statement. On the back of our analysis, we were invited to respond to the Health Committee’s annual public expenditure inquiry.
Pressures on the NHS continued into the summer, despite the expectation of a wane in demand. As Jeremy Hunt announced a ‘managed breach of waiting times targets’, Holly Dorning got behind the numbers to bust a few myths about the seasonal trend regarding waits for planned surgery. Holly’s waiting times analysis also featured in the Nuffield Trust’s first Buzzfeed earlier in the year.
Just after parliament returned the parties headed off for their annual party conferences. Jointly with the BMA and the RCN we held fringe events at the Labour, Conservative and Liberal Democrat conferences. These ‘In Conversation’ events in which a senior journalist interviewed Jeremy Hunt, Andy Burnham and Norman Lamb, proved to be amongst the busiest and highest profile health debates on the fringe. The care of people at the end of life was one of the many key topics discussed in health policy debates at the party conferences – we continued to be active in this area and published a new piece of analysis that explored the costs of care at the End of Life Care.
October 2014 will be remembered for the publication of Simon Steven’s Five Year Forward View, which set the future direction for health services in England. Nigel Edwards played an informal advisory role to NHS England on the sections on new models of care, wrote several comment articles in national media, and participated in media interviews. The Forward View also referred to new analysis on the pressures on hospital beds – the only think tank research cited in the document. Our busy October culminated in the Annual Statement of our QualityWatch programme, which warned that some historic quality improvements were going into reverse. The findings featured as part of an Opposition Day debate on the NHS.
With six months to go before the General Election, we published the first in a series of policy briefings on hot topics. This briefing, asking: ‘Is General Practice in Crisis?’ was published alongside the results of a survey of 100 influential health and social care leaders that we will be regularly polling as the election approaches. In November we also updated our NHS in Numbers charts with a tricky Buzzfeed Quiz: How well do you know the NHS?
A year after our Director of Policy Dr Judith Smith chaired an independent commission looking at the future of pharmacy, we conducted a review of progress. Our report argued that pharmacists risked missing the chance to act as care-givers. It launched at an event in Westminster chaired by Sarah Wollaston, eliciting over a thousand mentions on Twitter. As the month continued, the NHS grappled with growing volumes of hospital admissions. Our Chief Executive Nigel Edwards has offered expert commentary to national news media on the implications of a winter crisis.
2015: A one year forward view
As we head into the General Election in mid-2015, we look forward to health being on the top of the political and social agenda. While it’s clear that – from primary to acute care, GP surgeries to large teaching hospitals – the entire health system is under strain, there’s also room for optimism. Innovative ideas are being tested, new models of care adopted and there’s a surprising amount of unity on where the health and social care system needs to be in the future. By helping to create, support and evaluate new ideas, and connecting leaders across the NHS, we aim to play our part in turning this optimism into reality.
Merry L (2014) '2014: A one year backward look' Nuffield Trust comment, 19 December 2014. https://www.nuffieldtrust.org.uk/news-item/2014-a-one-year-backward-look