1. Improving cancer diagnosis: is there a better way than naming and shaming?

    30 Jul 2014
    Comments

    In a drive to improve England’s record on cancer survival, Jeremy Hunt recently announced that he will 'name and shame' low-referring GPs. It’s clear that improving early diagnosis of cancer could improve survival. But it’s not clear how shaming GPs into referring more patients will solve the problem of delayed diagnosis.

    Continue reading
  2. A risk worth taking?

    24 Jul 2014
    Comments

    The concept of predictive risk, or using linked person-level data to identify the patients most likely to have future unplanned hospital admissions, is now firmly embedded in the NHS. Here at the Nuffield Trust we recently held our fifth annual conference on the topic.

    Continue reading
  3. 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.

    Continue reading
  4. Informing the public on information

    17 Jan 2014
    Comments

    Most of the services we receive nowadays (be it internet shopping, high street banking or health care) have a trail of data associated with them. We’ve come to expect that these trails will be used to help future interactions be more efficient for us and/or those providing the service.

    This applies as much to public as private sector services – though we’ve also come to expect that the public sector lags well behind the private sector when it comes to IT matters.

    In many cases this perception of the public sector is probably true (any luck making a GP appointment online...

    Continue reading
  5. Can telehealth reduce demand on GPs?

    28 Oct 2013
    Comments

    After several years in gestation, the Whole Systems Demonstrator (WSD) trial of telehealth is now producing a steady stream of outputs – most recently in the form of a paper looking at whether telehealth changed the frequency with which people used GPs and practice nurses.

    The WSD, one of the largest trials of its type in the world, focussed on one use of telehealth as a form of remote monitoring and support to help people better manage their chronic health conditions – which in this study meant either...

    Continue reading
  6. Predictive risk: an idea whose time has come?

    (Guest blogger)
    29 Jul 2013
    Comments

    The Nuffield Trust recently held its fourth annual conference on predictive risk - or applying statistical models to populations in order to identify patients who might benefit from health interventions of various kinds.

    The mere fact that this was the fourth conference on the subject shows that this is an idea with legs. And, indeed, it has just been given a boost by the Department of Health, which has included a directed enhanced service for ‘risk profiling and care management...

    Continue reading
  7. NHS @ 65: transparency is the future of the people’s NHS

    (Guest blogger)
    26 Jul 2013
    Comments

    You attend a hospital with your disabled daughter. You do this pretty much every day because your daughter has regular seizures and emergencies. Every time, you have to start all over again because the hospital doesn’t know who your daughter is. More paperwork.

    Then you wait and wait because the staff have to find a hoist to lift your child out of her wheelchair onto a bed. Why couldn’t you have called in advance to tell them she was coming? Hours and hours of waiting.

    This is the NHS in the experience of one mother I met recently: everyday indignities and inhumanities and, in...

    Continue reading
  8. Queen's Speech 2013: the impact of immigration on the NHS

    14 May 2013
    Comments

    The impact of immigration on the NHS has long been a contentious topic and the Queen's Speech last week, which outlined plans to restrict migrants' access to NHS care, has thrust it into the headlines once again. Yet hard data on the issue have sometimes been thin on the ground.

    In 2011, the Nuffield Trust published an analysis that looked at how often international migrants to England use hospital care in comparison with English-born people.

    To our...

    Continue reading
  9. Demanding your attention: Caldicott's Information Governance Review

    8 May 2013
    Comments

    Even its best friends will grudgingly admit that information governance is not a topic that grabs you by the lapels and demands your attention.

    That is, however, until some brave soul attempts to tweak the laws and directives around the use of data in the UK, at which point the issue suddenly becomes extremely interesting.

    The latest intervention in this area, the most important for some years, comes from an independent working party headed up by Dame Fiona Caldicott (of the original...

    Continue reading
  10. What role can patients play in improving quality?

    (Guest blogger)
    7 Mar 2013
    Comments

    Back in 2002, I learned a valuable lesson: The patient’s view is paramount.

    Building user involvement in Motor Neurone Disease was a service improvement project at King’s College Hospital that included an in-person support group, newsletter, dedicated telephone group, and an online asynchronous message board or ‘forum’.

    As the lead researcher wound down the project, the team found there were two young patients, diagnosed in their early 20s, still using the forum to communicate.

    That’s when I...

    Continue reading
  11. Predictive risk: to app or to automate?

    25 Oct 2012
    Comments

    The purpose of predictive risk modelling is to segment a given population on the basis of their risk of experiencing a particular outcome, for example an emergency hospital admission (Billings and others, 2006).

    This is often used for case finding, where appropriate prevention techniques are matched to each risk stratum. High risk patients will be a small minority of the total population, and the form of the intervention will change depending on the level of risk.

    The highest risk patients might receive a personal...

    Continue reading
  12. The cost of caring for people at the end of life

    (Guest blogger)
    16 Oct 2012
    Comments

    What role should social care play to support someone at the end of life to die in their own home? And how can health and social care services work together to make this choice a reality?

    Macmillan Cancer Support’s own research shows that, with the right support, 73 per cent of people with cancer would prefer to die at home – but only 27 per cent actually do. If people’s end of life wishes are to be respected, it is vital that we answer these two questions.

    Macmillan has been...

    Continue reading
  13. Should clinical commissioning groups invest in telehealth?

    8 Oct 2012
    Comments

    Telehealth is increasingly being advocated as a way to monitor patients remotely and better manage long-term health conditions. The Nuffield Trust was part of the largest randomised controlled trial in this area, “the Whole System Demonstrator” (WSD) – the initial results were published earlier in the summer.

    We held a seminar with practitioners, researchers and funders to discuss the remaining research that needs to be done, post WSD. Priorities were identified as;...

    Continue reading
  14. Exploiting the single payer inheritance

    28 Sep 2012
    Comments

    As a nation we probably have the best information on health care in the world.

    Data on service use, cost, and increasingly quality, across the whole population and for some years, and large chunks of it available at person-level (suitably anonymised) and linkable wherever the patient receives care.

    Useable to track costs, assess substitution of care, stratify the population by risk, track cohorts of patients through time, assess impact of interventions, spot good quality and efficient care, develop business cases for invest to save innovations, shape clinical behaviour, develop...

    Continue reading
  15. How useful are randomised controlled trials in evaluating new ways of delivering care?

    24 Aug 2012
    Comments

    In the Whole System Demonstrator (WSD) trial, a team of researchers studied the impact of installing telehealth technologies in patients’ homes to monitor their vital signs such as blood sugar levels. 

    Debate continues over whether the findings justify the Government’s policy of encouraging the NHS to invest more in telehealth. At the same time, the trial has raised a potentially even more significant discussion. 

    How useful are randomised controlled trials...

    Continue reading
  16. Does telehealth reduce hospital costs? Six points to ponder

    28 Jun 2012
    Comments

    The first results of the largest randomised controlled trial on telehealth were published in the British Medical Journal last week. Of the five arms of the Department of Health-funded 'whole system demonstrator' (WSD) trial, the first (conducted by a team here at the Nuffield Trust) examined the impact on hospital admissions and costs.

    The headline results so far: patients receiving telehealth care had just 0.14 fewer emergency admissions in the one year of follow up; and...

    Continue reading
  17. What is the impact of telehealth on hospital use?

    22 Jun 2012
    Comments

    This week, the British Medical Journal published the first results from one of the world’s most complex randomised controlled trials. Researchers at the Nuffield Trust led this analysis, which relied on collecting over a billion records of administrative data from more than 250 health and social care organisations.

    The trial’s aim was to evaluate “telehealth” – a way of using technology to support people with long-term health conditions such as diabetes, heart failure or chronic obstructive pulmonary disease....

    Continue reading
  18. Predictive risk – clinical scepticism, incentives and participation

    21 Jun 2012
    Comments

    Since the development of the original PARR and Combined Predictive Model tools, many PCTs have introduced these or similar case finding tools, to identify people at risk of unplanned hospital admissions.

    Our one-day conference for people interested in using predictive risk tools in health care took place last week. People from across the UK and further afield spoke about the ways in which these tools are being used, as well as highlighting some issues and cautionary tales that have come from experience in trying to introduce and use...

    Continue reading
  19. NHS information: speed up, join up, open up

    31 May 2012
    Comments

    Like me, you may have ‘Government document fatigue’. Page upon page of optimism and bureaucratese after a while resembles looking at a blank wall. And life, after all, is too brief a spark.

    Such were my uncharitable thoughts one hot evening this week settling down to read: The power of information: putting all of us in control of the health and care information we need. Yes, blancmange is in there, but the paper is the best attempt I’ve seen to weave together...

    Continue reading
  20. Where is the oomph?

    27 Apr 2012
    Comments

    With the showers has come a certain malaise tinged with queasy uncertainty.

    This could be a post-Bill slump in the NHS, a response to the long grind of making cuts with no end in sight, and the sheer weight of detail to be worked through with respect to the mass reorganisation outlined in the now Health and Social Care Act.

    The queasiness extends beyond health, look at local Government for example facing an average six per cent cuts rather than a ‘flat real’ settlement as in health.

    ...

    Continue reading