1. NHS and social care funding: speaking truth to piety

    30 May 2014
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    As the noise generated by last week’s local and European elections fades, political energy will now be directed towards defining the policy battlegrounds on which next year’s General Election will be fought, which will have to be much wider than immigration and the European Union.

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  2. Houston we need a solution: time to stop describing the problem

    3 Apr 2014
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    My start at the Nuffield Trust coincides with the anniversary of the new system and Simon Stevens’ first week in charge of NHS England.

    I’ve been spending time on international work for the last two years and have been somewhat concerned by the nature of the debate on health and social care recently.

    The first reason is that there is too little public discussion about the solutions to the financial challenges facing social care and the NHS.

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  3. Influencing GPs and the expanding role of Clinical Commissioning Groups

    1 Apr 2014
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    Since clinical commissioning groups (CCGs) moved into the driving seat of the commissioning system 12 months ago, the breadth of the job they are expected to do has become apparent.

    Responsibility for each of the big changes we are increasingly told that the NHS needs – better joint working with social care, further efficiency savings in hospitals, and radical change in the scale and scope of general practice – rests largely on the shoulders of CCG leaders as the key drivers of change.

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  4. Got a problem? Call 118

    30 Jan 2014
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    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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  5. Defining moments of 2013, predictions for 2014

    16 Dec 2013
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    What were your defining moments of 2013 for the NHS? There were several contenders, but for me there were two events that bookended the year.

    The first was the Francis Report published in February. This wasn’t for its monumental nature and vast number of recommendations but it was the moment when quality decisively displaced finance as the overriding imperative for Boards and managers.

    The consequences of this are unfurling from the...

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  6. The quality of care: we must keep watching

    21 Nov 2013
    Comments

    This week the Care Quality Commission (CQC) have published their annual report on the state of care. It provides a useful overview of the state of care services in England, and also tells us a little of the state of the regulator too.

    Everyone understands that these are difficult times for care services. The financial constraints introduced in 2010/11 are starting to bite and the NHS is still coming to terms with its recent re-organisation. Many people are worried about the impact this may be having on...

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  7. Who shall we hold to account?

    30 Oct 2013
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    In the old days at the start of this century, the Chief Executive of the NHS was the man in charge, clearly accountable for NHS success or failure at national and local level.

    True, politicians occasionally ‘interfered’, as well they might given their direct accountability to Parliament and the electorate. Some did so more than others. Alan Milburn famously filled all the executive positions from CEO to HR Director. His writ ran to the operation of a hospital morgue in Bedford.

    This may not have been the best way to run the service – it certainly had its limitations and faults...

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  8. The paradox of scale and localness in commissioning

    17 Oct 2013
    Comments

    The Nuffield Trust report is timely. Nine clinical commissioning groups (CCGs) have already planned to end the financial year in deficit.

    More may end up in deficit as the financial pressure on the NHS mounts and the new funding allocation formula creates winners and losers.

    The report identifies the work CCGs do in relation to engaging stakeholders as being critical. Involving clinicians, patients and the public in service redesign work has become fairly routine as CCGs try to reach their...

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  9. Improving local price setting – opportunities and challenges

    (Guest blogger)
    25 Sep 2013
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    Approximately £40billion of total NHS expenditure in 2011/12 was spent on local contracts for services that do not have nationally mandated prices. Until now little research has been done to assess just how effective these have been in delivering more for patients, with the focus being on national price setting.

    Recent Monitor research highlights that pressure on local commissioners to balance annual budgets may limit their potential to drive better quality care for patients through local contracts for...

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  10. 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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  11. Personal health budgets: potential and challenges

    (Guest blogger)
    28 Aug 2013
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    Starting in April 2014 the 56,000 people eligible for NHS continuing health care will be offered a personal health budget. Positive results from an independent evaluation of a three-year pilot programme provided sufficient evidence to take the approach forward.

    However, while the pilot programme has generated a lot of knowledge about how best to implement personal health budgets, important questions about how they can be sustained in the wider NHS are raised by next year’s roll out. These will need careful consideration as the roll...

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  12. The wisdom of the crowd: summer reading for Whitehall villagers

    1 Aug 2013
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    It is clear that Jeremy Hunt does not want to take on the role of Secretary of State for Health as envisaged by Andrew Lansley, and as designed in the Health and Social Care Act 2012.

    Confined to public health, focused on health outcomes, and at arm’s length from the NHS through the annual mandate – this was never going to work under normal circumstances, never mind when an election is looming and with the budget settlement for the NHS as it is.

    The Secretary of State will want to direct and...

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  13. CCGs: the current view from local GPs

    22 Jul 2013
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    Much has been written about the current pressures facing primary care. Perhaps it seems fairly predictable therefore, to hear that many GPs are finding it difficult to engage with the clinical commissioning opportunity.

    But unfortunately for CCG leaders working hard to increase involvement, it is the support and involvement from members that provides one of their greatest potential assets.

    So how big do GPs think the challenge is ahead? New research, along with a growing body of evidence, may provide a few tips.

    ...

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  14. Back to first principles: primary care for the future

    18 Jul 2013
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    Looking back over recent blogs about primary care written by Jonathan Tomlinson, Clare Gerada, John Macaskill-Smith and Helen Parker, three things stand out.

    First, there is consensus that general practice is under significant pressure, struggling to meet demand from patients, blamed for contributing to the alleged crisis in accident and emergency care, and exhorted to reassume responsibility for out-of-hours patient care.

    Second, the ‘special sauce’ of general practice – the relationship between a patient and their family...

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  15. NHS @ 65: the NHS cannot do it alone

    (Guest blogger)
    12 Jul 2013
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    We are in danger of losing our collective nerve over the future of the NHS. In 1948, in the midst of austerity and post-war national exhaustion, Britain created a comprehensive health service which offered care to those who needed it regardless of their means.

    It was a courageous idea whose time had come and it made compelling economic, political and social sense. It still does.

    In 2013 our far richer country can and should continue to embrace Aneurin Bevan’s vision. Of course we face very different...

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  16. 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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  17. NHS @ 65: tender, fragile, fragmented, strained, vulnerable

    (Guest blogger)
    4 Jul 2013
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    Tender, fragile, fragmented, strained, vulnerable. In disarray. At a cross-roads. These are just some of the words used by key contributors to the Nuffield Trust’s latest publication: The wisdom of the crowd: 65 views of the NHS at 65.

    The service has never been particularly good at celebrating its big anniversaries. The tenth, in 1958, was pretty much all sweetness and light. But most of the others – from the 20th through to the 50th – were overshadowed by one crisis or another, by a sense of foreboding, or by both.

    By contrast, the 60th, back...

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  18. The challenges facing our hospitals – doing what needs to be done

    (Guest blogger)
    20 Jun 2013
    Comments

    The litany of challenges facing hospitals is by now familiar: rising demand, spending restraint, making the best use of new technologies, and finding ways to adjust the acute sector to a world of chronic illness.

    A service that has struggled to make progress on productivity for decades now faces a future in which there will be no alternative but to make steady efficiency improvements, year on year, while at the same time maintaining a level of quality upon which vulnerable people depend.

    The task is daunting, but I remain an...

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  19. 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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  20. 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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