Public health

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.

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...

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...

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...

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’...

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-...

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...

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...

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...