1. Is clearance for hospital mergers about to get easier?

    (Guest blogger)
    10 Sep 2015
    Comments

    With the Competition and Markets Authority provisionally clearing the way for the merger of the Ashford & St Peter’s Hospitals NHS FT and the Royal Surrey County Hospital NHS FT, navigating the merger process might become a lot quicker. Andrew Taylor, co-founder of Aldwych Partners and an advisor on this merger, explains why.

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  2. Those worrying about the transatlantic trade deal should look closer to home

    6 Oct 2014
    Comments

    There has been a lot of concern expressed about the planned free trade deal between the European Union and the US, the Transatlantic Trade and Investment Partnership, and the impact it will have on the NHS.

    TTIP seems to combine a number of popular demons in health circles: privatisation, US healthcare, competition and Europe. The fact that the Department for Business, Innovation and Skills is leading UK negotiations on behalf of the NHS might also make those who remember the Working Time Directive nervous.

    So just how big a threat is TTIP to the way the NHS works?

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  3. The benefits to patients? Shining a light on the NHS merger regime

    (Guest blogger)
    24 Jun 2014
    Comments

    Last week was a landmark: a new competition authority (the Competition and Markets Authority (CMA) – itself the consequence of a merger) approved the first full merger of two NHS acute trusts. Their decision will allow the merger between Frimley Park Hospital NHS Foundation Trust and Heatherwood and Wexham Park Hospitals NHS Foundation Trust to proceed.

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  4. How to make Monitor the ‘people’s champion’

    (Guest blogger)
    24 Mar 2014
    Comments

    Frontier Economics hosted a roundtable discussion at the recent Nuffield Trust Health Policy Summit to discuss the development of economic regulation.

    We drew some (only some – yes, health care is different) inspiration from the experience of other regulators. The early days of Postcomm – the postal regulator overseeing a government-owned Royal Mail – provided some lessons.

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  5. Summit’s up: issues for the 2015 election

    26 Feb 2014
    Comments

    Just over a year to go to the next election and we are all in for a prolonged bout of campaigning. Come next March we will probably all be bored, waiting for it to be over having made up our minds. So now is the best time to get a sense of what will be coming – and our annual Health Policy Summit next week will offer some clues.

    Call me a wonk if you like, but I’m looking forward to Philip Collins reviewing the political scene and Jeremy Hunt and Andy Burnham strutting their stuff, along with further debate from Rt Hon Stephen Dorrell...

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  6. Got a problem? Call 118

    30 Jan 2014
    Comments

    The Care Bill seems to be passing through Parliament with barely a ripple. Except for Clause 118. This is the clause where the Government is taking the opportunity to ‘clarify’ the law surrounding the Trust Special Administrator’s powers to drag other trusts into the frame when considering what to do with a failing one.

    It stems from the successful judicial review over the proposed closure of Lewisham Hospital’s A&E department as part of the Special Administrator’s plans to deal with the...

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  7. Competition: acute mergers, service reconfiguration & the role of the authorities’

    (Guest blogger)
    5 Dec 2013
    Comments

    There has been a lot of controversy about the competition regime as it applies to the NHS. The recent Competition Commission decision to block the proposed merger between Bournemouth and Poole trusts continues to reverberate around the NHS.

    Acute mergers are important and will continue to occupy the competition authorities. Alongside them there is a much higher volume of changes to service provision, service...

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  8. Competition – an incentive for GPs?

    (Guest blogger)
    24 Sep 2013
    Comments

    It has been very well advertised that the Health and Social Care Act 2012 places GPs more at the centre of the health care landscape. That was the explicit intention of the Government. GPs have always combined a vital clinical role with a (related) role of gate-keeper into the wider health care system.

    The Act has given them an even more prominent role by handing a large proportion of the budget for health care spending over to clinical commissioning groups (CCGs) which GPs run. The importance of GPs in how health care evolves was emphasised by the importance...

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  9. Competition is not the way to improve general practice

    (Guest blogger)
    10 Jul 2013
    Comments

    I have lived and worked as a GP in densely populated urban areas for the last 12 years and so I read with interest and dismay, Neil Bacon’s enthusiasm for the findings of the Competition and Cooperation Panel’s so-called: Empirical analysis of the effects of GP competition.

    This showed that GPs with neighbouring practices less than 500 metres away made fewer referrals for certain conditions and had patients who were 0.1 per cent more satisfied than patients from...

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  10. Where next for hospital mergers?

    (Guest blogger)
    21 Jun 2013
    Comments

    Next week sees the deadline for responses to Monitor on their consultation on the proposed approach to advising the Office of Fair Trading on the benefits for patients of mergers involving NHS foundation trusts.

    It acts as a further reminder that competition and choice will play an increasing role in the NHS, challenging those involved in proposed hospital mergers to demonstrate that there are...

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  11. Would we know it if we saw it?

    30 May 2013
    Comments

    A week after the Government's integrated care pioneer programme kicked off, the evaluation of North West London's integrated care pilot was published. The ingredients of the pilot were sensible, for example: investment in IT, risk stratification and targeting of high risk patients, leadership, coordination of multidisciplinary groups, and project management.

    The results so far: high commitment by professionals; greater collaborative working across teams and with social...

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  12. The benefits to patients of 'healthy' competition

    (Guest blogger)
    28 May 2013
    Comments

    I once worked with a consultant who had an uncanny ability to extract the truth from his junior staff. When he suspected dubious information (such as “I’m sure the patient had a high erythrocyte sedimentation rate (ESR)”) he’d say, “Is that a guess, rumour, fact or lie?”

    Of course, he did it in such an intimidating manner that the answer was clear by the blood draining from the face of the poor, unfortunate wretch who didn’t have all the information to hand.

    The current debate about the absolute need to reorganise and improve the NHS often reminds me of that consultant’s total...

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  13. AQP roll out not guaranteed to lead to voluntary sector expansion

    (Guest blogger)
    22 May 2013
    Comments

    Well, we know when dealing with Government that rhetoric can outrun reality. Whether it's Blair or Cameron, they are eloquent on the need for an expansion of the third sector.

    And, let's face it, given the challenges of long-term conditions and the preponderance of the elderly in hospital beds, we know a major expansion of charity and social enterprise provision is the bedrock of reform.

    The recent evidence from the Foundation Trust Network (FTN) on ...

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  14. Bet the farm on information over competition

    30 Apr 2013
    Comments

    Odd isn't it that after ten years of policies to encourage competition and choice and ten years of an increasing share of NHS cash spent on non-NHS providers, the evidence base supporting the benefits of competition in health care is too thin to make a sound judgement.

    Odd, until you think of the evidence base to support integrated care, which is equally thin.

    No wonder there is such room for howls of protest and undisciplined debate which doesn't get us much further forward. No wonder existing regulations and...

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  15. The 'new' NHS and the emergency care challenge

    (Guest blogger)
    19 Apr 2013
    Comments

    This is a critical time for the NHS, with many key themes to discuss. But my start to the year is dominated by emergency care – a very practical challenge but one that raises important questions about culture too.

    Across the NHS we are really struggling with emergency activity. Even allowing for Norovirus and prolonged cold weather we are experiencing unusual pressure.

    The...

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  16. The NHS in numbers: performance in the boom years

    17 Apr 2013
    Comments

    Our new series of interactive charts: The NHS in numbers pulls together some key data on health care spending, activity, resources and performance. These charts broadly cover the boom years for health care in the UK, from the late 1990s to the early 2010s, reflecting the latest data publicly available from official sources.

    During this period, when Government spending on the NHS rose at the fastest rate experienced throughout its history, both public and private spending on health care increased year-...

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  17. 'There’s a way to do it better – find it'

    (Guest blogger)
    10 Apr 2013
    Comments

    When I arrived in Boston as one of the 2012-13 Harkness Fellows I had no idea what learning I would want to bring back from the US health system to the UK. The Fellowship provides a wonderful opportunity to stand outside the UK as well as the US system and look at the strengths and weaknesses of both.

    The greatest strength that I have so far seen in the US system is a genuine commitment to innovation.

    This came into focus, for me, at the 24th annual National Forum of the...

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  18. Snapshot survey on the NHS: is confidence faltering?

    6 Mar 2013
    Comments

    For the third year running, we have carried out a small, snapshot survey of the NHS amongst the policy makers, senior managers, academics and clinicians who are attending our forthcoming Health Policy Summit, which takes place on 7 and 8 March.

    This survey does not pretend to be representative in any way, but nevertheless provides a flavour of opinion amongst the 53 people who responded, in the wake of a year which has brought prolonged gloom about the prospects of improvement in the state of public finances and the passing and...

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  19. Size versus quality? Examining hospital mergers

    (Guest blogger)
    16 Jan 2013
    Comments

    Hospital mergers and reconfiguration are increasingly centre stage in the NHS. Several years of financial austerity, with more in prospect, is placing severe stress on hospital finances. The ability of hospitals to deliver the necessary annual cost reductions (in the order of five per cent per annum) through tactical savings schemes is fast diminishing.

    Instead, more radical options for cost saving are being considered, including merger and major reconfiguration – as evidenced by the Department of Health’...

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  20. The accountable lead provider: making integrated care a reality?

    (Guest blogger)
    19 Dec 2012
    Comments

    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...

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