1. The nitty gritty detail of integrating complex systems

    17 Apr 2014
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    Recently, on one of my clinical general practice days, I made 21 phone calls to a London hospital trying to leave a message asking a consultant to call me urgently. A patient I had seen at 9am had decided not to have a disfiguring operation for a cancer that was planned for 10 days later.

    I needed urgent advice about the options for reconstructive surgery so that I could have an informed discussion with her during the following week about the choice she had made.

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  2. Informing the public on information

    17 Jan 2014
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    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...

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  3. What has been happening to NHS productivity?

    (Guest blogger)
    23 Oct 2013
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    There seems to be some confusion about what has been happening to NHS productivity over the last few years. This confusion appears to stem from three primary sources.

    First, the ‘productivity’ label can be applied quite liberally. But productivity has a narrow definition: it is simply the ratio of outputs to inputs in production.

    So, productivity is not the same as ‘value for money’ – this requires some means of attaching social or consumer value to what is produced. While productivity counts the...

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  4. Predictive risk: an idea whose time has come?

    (Guest blogger)
    29 Jul 2013
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    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...

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  5. NHS @ 65: transparency is the future of the people’s NHS

    (Guest blogger)
    26 Jul 2013
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    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...

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  6. Demanding your attention: Caldicott's Information Governance Review

    8 May 2013
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    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...

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  7. Institutional entrepreneurs - it's the information that matters

    2 Oct 2012
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    There are three requirements for entrepreneurship to flourish: the capacity to invest and innovate; the autonomy to make decisions over resources; and the confidence that the fruits of success can be retained, either by the individual or the enterprise. Of course, these conditions are usually in place in properly functioning conventional markets, allowing entrepreneurs to invest, innovate and reap the rewards of success.

    In a recent Nuffield Trust seminar however,...

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  8. NHS VistA: The enlightened choice?

    (Guest blogger)
    12 Jul 2012
    Comments

    The potential value to the NHS of learning from the international experience of the electronic medical record (EMR) system, VistA, was identified in the January 2002 NHS Information Authority White Paper:Open Source Software and the NHS.

    Ten years on, and several billion pounds of investment later, the NHS is still without a satisfactory comprehensive electronic medical record system.

    Open-source software has gone from strength to strength...

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  9. Accessing person-level data in health care: debating the key issues

    16 Aug 2011
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    In 2010 the Nuffield Trust invited Dr Sarah Clark and Professor Albert Weale from University College London to look at the current regulations relating to the use of NHS data by researchers and analysts and to reflect on the social values such regulations invoke. 

    Their full report, together with a summary from the Nuffield Trust that explores the issues, can be downloaded from the publications area of our website.

    One of the elements of Clark and Weale’s report that I found particularly striking was their argument from public benefit.  As they...

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  10. Accessing health care data: the importance of collective reasoning

    (Guest blogger)
    16 Aug 2011
    Comments

    Benedict’s comments are very thought provoking, and his concerns about the data subject in the ‘public benefit’ model are particularly important.  To be clear, though, ‘public benefit’ may be a misleading term for our approach.

    What we seek to do is to balance the interests of individual data subjects in privacy and autonomy with the collective interests of society in more and better health research, rather than to give either of those interests priority, as we argue the current ‘consent or anonymise’ regime does.

    Still, the predominance...

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