1. £200m cuts to public health: the situation is getting serious

    16 Jun 2015
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    Dr Alisha Davies examines why the recent announcement from the Treasury of £200m in cuts to non-NHS funding has provoked serious cause for concern among public health organisations. 

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  2. Can the NHS help tackle the UK’s obesity epidemic?

    20 Mar 2015
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    “Obesity is the new smoking”, said Simon Stevens, Chief Executive of NHS England. “It is a slow-motion car crash in terms of avoidable illness and rising health care costs.”

    Is he right? And if so, can the NHS help work towards solutions, or only tackle the associated health need?

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  3. The health of our children, the health of the NHS

    30 Jan 2015
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    While there has been much focus on the challenges faced by the NHS of an ageing population, there has been less discussion at the other end of the spectrum. Children are the adults, and parents, of tomorrow – they represent the future. Their health in childhood is critical to their physical and mental wellbeing later in life. Protecting their health could translate into a healthier, sustainable NHS.

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  4. Openness should be in the DNA of every hospital

    (Guest blogger)
    6 Feb 2014
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    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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  5. 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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  6. Competition is not the way to improve general practice

    (Guest blogger)
    10 Jul 2013
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    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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  7. NHS @ 65: the need for investment in general practice

    (Guest blogger)
    8 Jul 2013
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    The NHS is struggling and general practice is one area bearing the brunt of the pressure to meet increasing, and changing, patient needs.

    We have a growing and ageing population in the UK. From a GP’s point of view, we are seeing more patients than ever before, making up to 70 patient contacts a day, which previously would have only been seen in exceptional circumstances, such as a flu pandemic.

    And these patients are often presenting with complex, chronic and multiple conditions, both physical and mental.

    Additionally, another round of...

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  8. 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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  9. Reconfiguration versus re-election: public expectations and health reform

    (Guest blogger)
    24 Jun 2013
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    Clinicians and health service administrators can often identify ways of reconfiguring services, particularly hospital services. These reconfigurations usually appear to deliver improved outcomes but prove hard to sell to a sceptical public. On these occasions, local politicians are urged to be brave and support such moves.

    All too often though, the politician is found fanning the flames of popular discontent and those inside the NHS look upon them with varying degrees of sympathy, bewilderment, despair or contempt. The situation is actually made worse if health insiders believe that...

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  10. The benefits to patients of 'healthy' competition

    (Guest blogger)
    28 May 2013
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    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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  11. Transforming general practice: GP providers thinking big

    23 May 2013
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    General practice seems to be considered by politicians and the media as both the cause of and solution to the current crisis in demand for urgent and emergency care.

    At the same time, the primary care community is recognising that the current business model of general practice is under threat due to increased demand by patients, growing regulatory workload and, for some this year, significantly less income.

    From discussions with GPs and policy makers, there appears to be some consensus that the current ‘small scale’...

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  12. How primary care providers can rise to the challenges of the public health agenda

    (Guest blogger)
    25 Apr 2013
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    The release today of a crucial report written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC) sets out the challenges that face primary care and general practice.

    In particular, the report looks at moving from a purely curative and reactive based approach to patient care, to one that is balanced against making significant inroads into the reduction of the rise in chronic ill health set against the backdrop of an ageing population.

    As the NHS struggles to meet unprecedented financial efficiency...

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  13. The NHS in numbers: performance in the boom years

    17 Apr 2013
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    Our new series of interactive charts: The NHS in numbers pulls together some key data on health care spending, activity, resources and performance. These charts broadly cover the boom years for health care in the UK, from the late 1990s to the early 2010s, reflecting the latest data publicly available from official sources.

    During this period, when Government spending on the NHS rose at the fastest rate experienced throughout its history, both public and private spending on health care increased year-...

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  14. New Year, new 'to do' list

    17 Jan 2013
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    There is nothing like the New Year for compiling a 'to do' list, and nothing more satisfying than to start the list with some things you already have under way, so that you can tick a few off immediately. Last week the coalition Government gave us their version in the form of the Mid-Term Review.

    The NHS chapter pulls together a series of previously announced service initiatives (e.g. rolling out telehealth and telecare, implementing a 'friends and family test'); details of their performance meeting targets and initiatives put...

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  15. Our health service presents wicked problems

    (Guest blogger)
    26 Jul 2012
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    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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  16. All for one, one for all: GP-led organisations & their government masters

    8 May 2012
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    Is it possible to have strong general practice (GP) ownership of a primary health care organisation, whilst pursuing a population health agenda? Geoff Meads termed this age-old tension between general practice and public health the attempt to mix oil and water.

    In mineral-rich but water-poor Australia recently, I had a strong sense of déjà-vu about the general practice-public health tension.

    Australia is setting up a national network of 'Medicare Locals' as part of wider health reforms. These new organisations will be responsible for planning more integrated, local primary and...

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  17. Is data the new hero of the NHS story?

    30 Nov 2011
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    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...

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  18. Let's talk business: Public health, people and money

    15 Nov 2011
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    The Government’s reform of public health services (detailed in the White Paper: Healthy lives, healthy people: our strategy for public health in England) has reignited debate about the importance and future of public health in the English NHS.  Although admittedly that discussion has sometimes been drowned out by the sound and fury provoked by the wider structural reform programme.

    The key argument for retaining public health involvement in the new system...

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  19. NICE and the NHS Constitution: a partial reprieve for clinical commissioners?

    11 Aug 2011
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    An interesting thing occurred when Andrew Lansley announced that NICE would no longer recommend which drugs and treatments should and should not be offered on the NHS – NICE became, well nice.

    The alternative, new local commissioners having to make these decisions at a local level looked inequitable and unworkable.  After all, NICE has been a lightening conductor for public anxiety around rationing, and has taken difficult and highly technical decisions out of the hands of local commissioners.

    Following a recommendation from the...

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  20. Public health specialists shouldn't wait to be asked

    27 Jul 2011
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    Finally there is more detail on how public health will be delivered in the future. The Government’s response to its consultation on the Public Health White Paper: 'Healthy Lives, Healthy People', goes some way to addressing the key gaps that we and others have identified around commissioning, but other issues are still far from resolved.

    Right now public health specialists work closely with commissioners to conduct needs assessments and evaluate service outcomes.  They...

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