1. Could health and wellbeing boards really work as a single commissioner?

    3 Oct 2014
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    When Health and Wellbeing Boards (HWBs) were introduced in local authorities (LAs) in 2012, their original purpose was to improve the health and wellbeing of local communities and reduce inequalities by promoting integration across health, care and other services.

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  2. If only we could focus on the end rather than the means

    1 Oct 2014
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    My heart sank when we got a glimpse of Labour’s thinking about post-election health policy, with hints that hospitals would be expected to evolve into integrated care organisations providing...

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  3. Counting the cost of end of life care

    25 Sep 2014
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    Our health services are not just about our health. They are also heavily involved in our deaths.

    This year, for every 1,000 people in England, nine will die. Eight of those nine will have some hospital care during their final year of life. For four or five, a hospital bed will be their last.

    Unsurprisingly, people who are near to the end of their lives are disproportionately high users of hospital services. We estimate, that approximately 15% of all emergency hospital admissions in England belong to the 1% of people in their final year of life.

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  4. The ‘wicked’ problem of access: is the telephone a solution?

    6 Aug 2014
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    This week a study in the Lancet concluded that phone consultations with patients who request same-day appointments generate additional work for GPs when compared to face–to-face encounters. In some ways, the study provides further evidence for the existence of induced demand – the phenomenon that widening access for health care fuels use – that we highlighted in a recent Nuffield Trust report (June 2014).

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  5. Making hospitals fit for the frail older people who actually use them

    (Guest blogger)
    19 Jun 2014
    Comments

    On June 9, I finished my ward round of 24 inpatients – median age 80-plus, legged it to the station and got into London just in time to set up my workshop on models of care for frail older people at the Nuffield Trust Future Hospitals conference.

    At the event, I presented some challenging ‘home truths’ alongside an animation and some practical solutions.

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  6. The future of the hospital: some useful lessons

    13 Jun 2014
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    NHS England Chief Executive Simon Stevens issued his challenge to rethink the role of the hospital in more imaginative ways after this week’s Nuffield Trust’s conference on the future of the hospital was already in the diary.

    There were some clear lessons from our audience of hospital leaders – many on the theme that simple answers of hot-cold splits (separating emergency from elective care), centralisation, mergers etc are not working. I took away a number of lessons. 

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  7. Local leaders unleashed? What to expect from Simon Stevens’ reign

    4 Jun 2014
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    The response to NHS England Chief Executive Simon Stevens’ first interview says as much about the challenges facing the NHS as the content of the interviews themselves.

    Mr Stevens’ message – to be pragmatic, to decide what’s right locally, to be bold, and to look beyond current bricks-and-mortar configurations – quickly transmuted under the media spotlight into one of harking back to a bygone age of cottage hospitals...

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  8. General practice needs more than money

    3 Jun 2014
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    It seems that hardly a week goes by without another report of workload pressure, lack of funding and general imminent doom in general practice. As a response to this, the Royal College of General Practitioners (RCGP) has its Put Patients First: Back General Practice campaign, and the British Medical Association have Your GP Cares. Both focus on the need for more money to ease the pressures faced by GPs and their teams.

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  9. 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.

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  10. 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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  11. The Better Care Fund: do the sums add up?

    8 May 2014
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    Yesterday's Guardian reports that the Government’s plans for the Better Care Fund have been put on hold as the Cabinet Office demand that the Department of Health do more to explain how the savings needed to pay for it will be secured. Government sources have been quick to dampen speculation that this signals trouble for the plans.

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  12. 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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  13. Working at change: responding to the Francis Inquiry

    (Guest blogger)
    4 Mar 2014
    Comments

    MBA students in the United States are now taught about the Mid Staffordshire NHS Foundation Trust Public Inquiry as a case study of institutional behaviour when leaders lose sight of their values. Will they one day also use the Care Quality Commission (CQC), as a case study of just how fundamentally a failing institution has to change?

    I know it’s stating the obvious, but I’m still amazed at how wrong decisions about the direction of an organisation (that are often relatively quick to make) can take literally years to turn around.

    Last week the CQC...

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

    26 Feb 2014
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    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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  15. Can payment reform promote better care?

    (Guest blogger)
    20 Feb 2014
    Comments

    The NHS payment system defines the mechanisms through which NHS-funded care is paid for, and the prices paid. These mechanisms and prices are levers available to commissioners to incentivise providers to achieve health care objectives, such as better health outcomes, activity targets, greater efficiency, and reduced waiting times.

    For example, the “Payment by Results” system, through which hospitals are paid according to how much treatment they provide, was introduced to incentivise more hospital activity, at a time of long and growing...

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  16. After the Francis Inquiry: are we more aware of care quality?

    (Guest blogger)
    18 Feb 2014
    Comments

    When opening the Nuffield Trust Francis one year on conference, Rt Hon Stephen Dorrell MP described the second Francis Inquiry Report as a ‘seminal event that needed to become a transformative one’.

    The Nuffield Trust report: The Francis Report: one year on states that hospitals have taken significant heed of Francis, and have focused in many and varied ways on care quality, compassion, complaints, nursing and openness and transparency.

    ...

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  17. Openness should be in the DNA of every hospital

    (Guest blogger)
    6 Feb 2014
    Comments

    Four years ago I published a report laying bare the shocking care provided at Stafford Hospital. I heard of an elderly patient left naked in public view covered in faeces, of another who died because she not given insulin, of wards where elderly patients were not helped with food and drink, of an A&E where waiting times were fabricated.

    Staff who raised genuine concerns were not listened to or respected, and...

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  18. Is the NHS a safer place a year after the Francis Report?

    6 Feb 2014
    Comments

    Imagine that today, February 6 2014, you’ve just said goodbye to your elderly mum or dad, looking small, lost and confused in a hospital bed. They’ve been admitted after a fall at home and you’ve been told they’ll be in for a few days, and not to worry because they are in safe hands.

    But you do worry, because you remember reading all those stories about what happened in Mid Staffordshire Hospital. You worry about whether, at 2am in a darkened ward, there isn’t something similar going happen to your mum or dad, if they won’t be...

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  19. 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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  20. 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...

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