In my clinic last Friday I was shocked: four out of sixteen appointments were taken by patients who were unable to gain access to the hospital services they had been told they needed. Having each tried to contact the hospital several times, they came to me to ask for help in navigating hospital booking systems, for interim pain relief, and reassurance. GP appointments that should have been available for clinical problems were used for administrative support, alongside clinical advice on the symptoms that arose from delays in care.... Continue reading
31 Oct 2014Comments
(Guest blogger)8 Aug 2014Comments
6 Aug 2014Comments
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).Continue reading
27 Jun 2014Comments
According to the Commonwealth Fund’s latest report “Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares Internationally” which compares 11 industrialised countries, the UK has won the ‘World Cup’ of health care systems.Continue reading
(Guest blogger)24 Jun 2014Comments
Last week was a landmark: a new competition authority (the Competition and Markets Authority (CMA) – itself the consequence of a merger) approved the first full merger of two NHS acute trusts. Their decision will allow the merger between Frimley Park Hospital NHS Foundation Trust and Heatherwood and Wexham Park Hospitals NHS Foundation Trust to proceed.Continue reading
(Guest blogger)19 Jun 2014Comments
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.Continue reading
30 May 2014Comments
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.Continue reading
17 Apr 2014Comments
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.Continue reading
11 Apr 2014Comments
Criticism of the Welsh NHS is a popular sport for English ministers. David Cameron takes regular pot shots at longer waiting times and failure to hit A&E targets.
To the politically cynical, it looks like a straightforward attempt to brand Labour, who governs in Wales, as a party that cannot manage the NHS.Continue reading
(Guest blogger)26 Mar 2014Comments
The number of people receiving care – working age disabled people and their carers, as well as older people whose case is so powerfully made in this report – is being rationed, leaving thousands of people previously eligible without any local support.Continue reading
19 Mar 2014Comments
Today’s Budget contained no new announcements when it comes to health and social care. While the continuation of austerity beyond the next election will almost certainly mean more tough decisions on public spending in the next spending review, today was all about warming up to electorate for the election with eye-catching policies on tax and pensions.
The big news as far as the NHS is concerned had already been announced: last week the Government set out its decision on NHS pay over the next two years.Continue reading
(Guest blogger)4 Mar 2014Comments
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...Continue reading
26 Feb 2014Comments
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...Continue reading
(Guest blogger)20 Feb 2014Comments
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...Continue reading
(Guest blogger)18 Feb 2014Comments
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.
(Guest blogger)6 Feb 2014Comments
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...Continue reading
6 Feb 2014Comments
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...Continue reading
30 Jan 2014Comments
The Care Bill seems to be passing through Parliament with barely a ripple. Except for Clause 118. This is the clause where the Government is taking the opportunity to ‘clarify’ the law surrounding the Trust Special Administrator’s powers to drag other trusts into the frame when considering what to do with a failing one.
It stems from the successful judicial review over the proposed closure of Lewisham Hospital’s A&E department as part of the Special Administrator’s plans to deal with the...Continue reading
(Guest blogger)29 Jan 2014Comments
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.Continue reading
17 Jan 2014Comments
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...Continue reading