1. The population time-bomb: can NHS spending keep pace?

    19 Nov 2014
    Comments

    Eighteen months ago, the protection of NHS spending was not a popular position in Whitehall. Other departments, cut to the bone and facing more of the same, were envious. Politicians as different as Vince Cable, from the Lib Dem left, and Phillip Hammond from the Tory right, lobbied hard for the health service to “share the pain”.

    Continue reading
  2. 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
  3. 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
  4. I have to readmit – it’s getting better

    (Guest blogger)
    7 Apr 2014
    Comments

    Hospital readmissions for emergency care have been the subject of policy attention for a few years. The common view is that they are preventable by a better standard of care; however the reality is much more complex.

    Our research, published in the Emergency Medicine Journal, throws some light on this reality.

    Continue reading
  5. Virtual reality: observations from the Nuffield Trust study of Virtual Wards

    6 Nov 2013
    Comments

    Implementing new models of care is not easy – and especially so when organising community-based services that aim to tackle the challenges of more chronic disease and greater levels of emergency care.  

    One of the more interesting approaches of the past few years has been the Virtual Ward and we recently published a report, funded by the National Institute for Health Research Service Delivery and Organisation Programme, looking at three early examples of Virtual...

    Continue reading
  6. Refining the case finding model

    27 Aug 2013
    Comments

    The Nuffield Trust has just published a paper on a new predictive model. We hope that the paper and the accompanying details can help both commissioners and providers of care refine the ways that they use risk stratification and case finding tools.

    The market for predictive modelling tools has grown a lot in the last few years. Alongside the old familiars, such as Patients At Risk of Re-hospitalisation (PARR) and the...

    Continue reading
  7. Can telephone health coaching prevent hospital admission?

    7 Aug 2013
    Comments

    Health services around the world are attempting to improve care for people with long-term conditions, as currently it is often fragmented and expensive. Many interventions have been tried and tested. To the long list of evaluations another can now be added – that of Birmingham OwnHealth (published today in the BMJ).

    Birmingham OwnHealth was England’s largest example of telephone health coaching, established in 2006. Operating as part of...

    Continue reading
  8. 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
  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. 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
  11. 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
  12. Predictive modelling – enthusiasm versus pragmatism

    (Guest blogger)
    27 Jun 2012
    Comments

    It was a privilege to present the progress we’ve made in Devon at the predictive risk 2012 conference. Both Todd Chenore and I appreciated the chance to outline our results of integrating predictive modelling into a whole system approach, which appear to be consistent and transferable to other areas.

    Predictive modelling and virtual wards in Devon began with three practices in North Devon in 2008 and the service now covers three distinct localities across Devon.  They have implemented the service in three slightly different ways...

    Continue reading
  13. 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
  14. A nicer challenge for 2012?

    16 Dec 2011
    Comments

    OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

    Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

    Alan brings together his long experience of analysis in the US, and his...

    Continue reading
  15. Person-based Resource Allocation: a clinician's perspective

    (Guest blogger)
    16 Dec 2011
    Comments

    I have to confess that it was with some trepidation that I stepped into the Nuffield Trust one November morning to hear first-hand of the progress on Person-based Resource Allocations (PBRA), designed to allocate about one third of the total budget that will be available to clinical commissioning groups (CCGs).

    The thought of trying to keep pace with Martin Bardsley’s technical wizardry around such a key issue was always likely to move me out of my comfort zone in the familiar thought patterns embedded in my basal ganglia and deliver a...

    Continue reading
  16. Is data the new hero of the NHS story?

    30 Nov 2011
    Comments

    The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.

    Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.

    The second was para 4.24 – in response to...

    Continue reading
  17. Risk prediction: what every CCG needs to know

    17 Nov 2011
    Comments

    Keen readers of this blog will already know about the importance of risk prediction in health. As my colleague, Dr Geraint Lewis, has pointed out: “neither doctors, nurses nor case managers [are] able to predict which patients [are] at highest risk of readmission to hospital.”

    So, if the NHS is to target effectively the ever increasing rate of emergency admissions, it is clear that it needs some help from predictive risk tools.

    When the...

    Continue reading
  18. Summer fun and international learning on health care reform

    17 Aug 2011
    Comments

    In the welcome breather from discussions over the Health and Social Care Bill, Nuffield Trusters have had a distinctly international flavour to our work. Professor Alan Garber, soon to be Provost at Harvard, gave our Rock Carling lecture examining how competition can coexist with developing integrated care. 

    In the Q&A he gave some provocative responses: don’t rule out all forms of price competition for clinical care; and give GPs some direct (i.e. personal income) incentives for commissioning well.  For more details...

    Continue reading
  19. PARR++ is dead: long live predictive modelling

    12 Aug 2011
    Comments

    Earlier this year, the Journal of General Internal Medicine published new research, which showed that neither doctors, nurses nor case managers were able to predict which patients were at highest risk of readmission to hospital. 

    This finding is important because if we are to tackle the health problems that manifest as unplanned hospital admissions then we need to be able to predict and prevent these events at the individual level. Unplanned admissions cost the NHS an ...

    Continue reading
  20. Predicting the future of predictive risk

    14 Jul 2011
    Comments

    Our recent conference on risk adjustment focussed on applications where the stakes are highest – namely risk adjustment linked with the funding and reimbursement of health care services.

    The morning session included a description of the work on person based resource allocation (PBRA), with Professor Peter Smith (Imperial College London) and Robert Shaw (Department of Health) presenting. Current work on a PBRA formula for the NHS in England will see risk adjustment being used to set GP practice and possibly...

    Continue reading