1. Under pressure: hospital organisation in Europe

    (Guest blogger)
    29 Jan 2014
    Comments

    Hospitals across Europe are under pressure. They all tend to have business models which rely on growing income and payers that are increasingly trying to contain them.

    Big questions are being asked about future strategy but there is surprisingly little public debate about this important part of the health system and there is insufficient policy analysis.

    Our recent European Summit brought together leaders and analysts from across 16 countries to compare notes. This revealed some interesting differences...

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  2. What does the new drugs deal mean for the NHS?

    18 Nov 2013
    Comments

    The new Pharmaceutical Price Regulation Scheme (PPRS) agreement looks like a good deal for the NHS.

    Getting the budget fixed for the next five years for a sizeable chunk of spend is good news. It also matches the expected trend of spending and immediate pressures on the NHS with zero increases in the branded drugs budget in 2014 and 2015 and thereafter only a two per cent increase (i.e. more or less in line with expected inflation) in each of the remaining...

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  3. 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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  4. 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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  5. '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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  6. 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...

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  7. 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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  8. Asking tough questions about primary care

    (Guest blogger)
    13 Feb 2013
    Comments

    Health care reformers tend to focus attention on hospitals and payment systems and yet primary care, where most patients are seen, receives comparatively little attention.

    While it is acknowledged that hospitals are now poorly suited to the different types of patients they have to treat, the fact that primary care faces similar problems is rarely acknowledged. The recent Nuffield Trust European Health Summit, supported by KPMG sought to redress this balance.

    Across Europe, primary care is often characterised by small and isolated practices, with few...

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

    2 Oct 2012
    Comments

    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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  10. 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...

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  11. Candy coated cartels, fear and loathing: is there a better way forward?

    8 Aug 2012
    Comments

    “Integration…is like M&Ms…a thin, sugary veneer of medical ‘science’ over a yummy core of price fixing…” (US Healthcare Executive).

    Over the last 12 months I’ve been researching the impact of competition policy on delivery system innovation and payment reforms that promote greater integration. My question has been: how might policy makers, regulators and health care leaders work constructively to produce an informed and proportionate competition regime applied to the NHS?

    In the US, health care providers are united in the view that competition concerns – namely the fear of...

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  12. Our health service presents wicked problems

    (Guest blogger)
    26 Jul 2012
    Comments

    The Nuffield Trust’s new NHS reform timeline is a salutary reminder that the NHS, and health services internationally, teem with ‘wicked problems’.

    A phrase originally used in social planning, this describes problems difficult or impossible to solve because of incomplete, contradictory, and changing requirements, often hard to define. Sometimes those seeking to solve the problems are also causing them. Often one wicked problem is merely a symptom of another one.

    Solutions to wicked problems are better or worse, not right...

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  13. 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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  14. 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.

    ...

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  15. Helping hands are better than praying lips: reflections on the 2012 Summit

    9 Mar 2012
    Comments

    High stakes with the Health and Social Care Bill last week. But at our Health Policy Summit 2012 we pushed aside for a minute big reform, structures, and long run consensus-dividers such as competition/choice, public/private, and command versus autonomy.

    Instead, we majored on – as guest Don Berwick so thoughtfully put it – ‘contextually adaptive changes’.

    A physician who was formerly chief of the Centers for Medicaid and Medicare and the Institute for Healthcare Improvement, Don was upbeat that with the right changes...

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  16. Could providing hospital care for the elderly bankrupt Britain?

    (Guest blogger)
    1 Mar 2012
    Comments

    Annual per capita growth rates in acute care costs are increasing fastest for older adults.

    Given that this growth rate is expected to continually increase, it is imperative that we increasingly focus our efforts around developing new cost-conscious models that are also able to meet the complex needs of older patients.

    The biggest problem is that our current hospital care model was developed years ago when most adults tended to not live past 65 or were living with chronic illnesses and usually only had one active problem that brought them to hospital.

    While things still...

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  17. New patterns of innovation in health and care

    (Guest blogger)
    29 Feb 2012
    Comments

    Data from countries within the Organisation for Economic Co-operation and Development (OECD) shows a roughly inverse correlation between spending on health (as a share of GDP) and mortality, and a roughly inverse correlation between growth in spending on health and improvements in mortality (the correlations hold even if the US is excluded).

    These glaring facts are likely to force ever more attention on health productivity, health innovation and the adoption of models from elsewhere that can demonstrably...

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  18. Searching for innovation: the 2012 Health Policy Summit

    28 Feb 2012
    Comments

    The Nuffield Trust’s fourth Health Policy Summit opens on Wednesday, bringing together senior health leaders, clinicians, policy-makers and academics. The timing is not auspicious.

    The intense political wrangling over the Health and Social Care Bill has spilled out beyond Westminster and is dividing professionals in the NHS. Even at this late stage the Bill’s passage through Parliament is uncertain.

    Whatever you might think of the Government’s proposals, the financial challenge that predated them is now a reality for the NHS. It is also rapidly becoming...

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  19. Keeping patients' trust

    (Guest blogger)
    17 Feb 2012
    Comments

    Last year the Archbishop of Canterbury attacked what he described as "the quiet resurgence of the seductive language of the deserving and undeserving poor".

    The pressure to make huge savings within the NHS, coupled with the commissioning agenda and the introduction of private competition to that process could see the deserving and undeserving poor joined by the deserving and undeserving sick. This can't be right. After all, no one chooses to be sick.

    When I hear insulting terms like "frequent flyers" being used to describe people who are sick and need...

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  20. A model medical leader

    15 Dec 2011
    Comments

    I have been in Boston for a few months now, and the weather has turned.  We were robbed of a spectacular New England Fall. Some blamed the hurricane; some the earthquake; the more scientific amongst us, the temperature.

    Fall was delayed as the chlorophyll rich leaves persisted due to the stimulation of an atypically warm and sunny October/November. After weeks of patiently waiting for the leaves to change colour, they changed abruptly and fell almost without anyone noticing.

    Around the same time, Don Berwick was quietly making ready his notes for his successor as he was...

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