It’s Christmas, and hopefully you’ll soon find yourself curled up somewhere for some quiet time to catch up on all the reading you meant to do this year. With that in mind, we’ve compiled a few of our best blogs and publications that you may have missed over the last 12 months. Here you’ll find six long reads and six short reads to see you into the new year.
Six long reads
This year saw a renewed focus on digital health care in the NHS: Simon Stevens launched the first wave of NHS innovation test beds in January, while September saw the long-awaited release of the Wachter review, Using information technology to improve the NHS. Delivering the benefits of digital health care, our most read publication of 2016, set out the possibilities to transform health care offered by digital technologies. It draws on the successes of Dr Wachter and other clinical leaders from across the globe. And if infographics are your thing, we also set out the world of digital health in numbers.
The financial challenge facing the NHS is widely acknowledged. What is less clear is how exactly it is expected to close its budget gap. We know that the NHS is already struggling to cut costs: the end of this financial year showed that hospitals overspent by an unprecedented £2.45 billion in 2015/16. Ground-breaking analysis by Sally Gainsbury found that only with unprecedented provider efficiencies, reductions in activity growth and dipping into the Sustainability and Transformation Fund will it even be possible to balance the books. Even if providers continue to deliver 2 per cent savings each year, the health service will still face a funding gap of £6 billion in 2020. Check out the publication’s interactive charts for a clearer picture of how things are looking under the bonnet for NHS finances.
In recent years in the NHS, all eyes have been on new models of care – pioneers, vanguards and most recently STPs – to redesign the way health care is delivered to patients. Yet the capacity for NHS staff to deliver these models has often been overlooked. This report, widely covered by national media, argued that developing and extending the skills of the non-medical workforce, including nurses and pharmacists, is a 'must-do' to sustain the future of new care models and meet the changing needs of patients. It also called for greater investment in training budgets for existing NHS staff.
Traditional general practice is changing – three quarters of practices are now working collaboratively in large-scale organisations. Policymakers and practitioners have high hopes for these organisations, and for their potential to transform services both within primary care and beyond. But can they live up to expectations? This major 15-month study found that, while large-scale GP organisations are helping practices cope, there are few signs yet that they can improve care. The recommendations and findings laid out in the report will prove increasingly important in 2017 as more practices attempt to scale up under pressure.
There have been multiple examples of improvement of health services over the years, but often they can be hard to identify and much of the evidence of their effectiveness is anecdotal. Thankfully, we’re increasingly able to use data in innovative ways to learn more about what works and what doesn’t. This report explores pioneering methodologies for finding best practice in the care of frail and older people, with the hope that we can share lessons from the best the NHS has to offer.
Children's health services are still heavily weighted towards reactive hospital services rather than prevention, in spite of a shift away from infectious illness towards chronic long-term conditions. Our briefing examined the potential for new models of child health services – which have been emerging both within the Vanguard scheme and inspired by it – and how they are responding to these issues. The report then imagines an ideal child health system: one that understands children, young people and their families’ specific needs; where there is access to high-quality paediatric expertise; and where there is linked-up, timely information, communication, data and care.
Six short reads
1. How are Sustainability and Transformation Plans coming together? Nigel Edwards
This summer, the campaigning group 38 Degrees led an investigation into the Sustainability and Transformation Plans (STPs), bringing them to the attention of the general public for the first time. News headlines focused on the plans’ potential for cuts to hospital beds and services, but very little was actually known about the detail of the 44 plans being drawn up across the country. Following a workshop with STP leads and analysis of draft plans, Nigel Edwards outlined in a series of blogs what we know about STPs, their assumptions about efficiency savings and whether they would be likely to succeed. Summarising in his most recent blog in the series, Nigel says: “The NHS will go into next year with no plan B and, in some cases, with plan A far from complete.”
2. The facts on Brexit. Mark Dayan
While the EU referendum is now done and dusted, the consequences of Brexit for the NHS – indeed for the UK as a whole – remain far from resolved. Two blogs by Mark Dayan published ahead of the referendum examined what leaving the EU might mean for the health service. While “Brexit means Brexit” may be Theresa May’s mantra, there is still much uncertainty about the position of EU immigrants residing in the UK, which is a real concern given that 4 per cent of UK nurses and 10 per cent of doctors are EU immigrants. Mark’s analysis also found that leaving the EU was unlikely to relieve pressure on the service, since the impact of immigrants’ use of the NHS is minimal compared to other factors such as ageing and rising costs. As we move into 2017, only time will tell just how important these findings are.
3. Weren't new care models supposed to solve the NHS crisis? Paul Corrigan
The defining rhetoric for the NHS this year has been around efficiency savings, cost cutting and sustainability. In a guest blog for the Trust published in May, Paul Corrigan argues that the current model of 'stabilise first, transform second' is drastically at odds with the original ambitions of the Five Year Forward View. Putting off the hard work of transformation until we have ‘dealt’ with the deficit was not the narrative of NHS England’s plan for the NHS. Instead of trying to stabilise the old system, Paul argues that we should be focusing all energy into transformation to develop a new system that avoids the pitfalls of the old one.
4. Can we afford the NHS in the long term? John Appleby
NHS finances have been under a fair amount of scrutiny this year. The NHS is going through a decade of austerity, but demand for health care continues to rise. There is clearly widespread anxiety about the future of the service, with much speculation that we will need to find new ways to fund the service. Clearly the NHS needs more money in the short term, but what about the future? In a blog published this autumn, Chief Economist John Appleby assessed new spending projections from the Office for Budget Responsibility, which estimate a rise in public spending to 8.8 per cent of GDP in 15 years. In analysis of the figures, John argues that it will be possible to fully fund the NHS in the future. The bigger question is how?
5. Where is the public pressure for social care reform? Ruth Thorlby
This year, we found in our research with The King's Fund that older people are paying the price for cuts to social care, with 400,000 fewer people receiving the care they need. Yet, as Ruth Thorlby wrote poignantly following the launch of the report, the public outrage and demand for change that could mobilise political action has so far been non-existent. While the recent funding settlement for local government is a start, it will address just a quarter of the £1.9 billion funding gap next year, and more people and their carers will continue to struggle as a result. With the 2017 funding crisis in care looking no less formidable, Ruth’s blog is timelier than ever.
If you’ve followed the state of NHS finances at all this year, chances are you’ll have heard a lot of numbers about what is owed and to whom, what has been paid, how much has been saved and when everything is supposed to be settled up. It’s easy to get confused, particularly when some of the numbers you’ve heard are contradictory or just plain wrong. That’s why earlier this year we pulled together a Buzzfeed explainer (complete with cat gifs) that tells you everything you need to know about money in the NHS.
Nuffield Trust (2016) 'Highlights from 2016: 12 Christmas reads'. Nuffield Trust comment, 21 December 2016. https://www.nuffieldtrust.org.uk/news-item/highlights-from-2016-12-christmas-reads