1. How to make Monitor the ‘people’s champion’

    (Guest blogger)
    24 Mar 2014
    Comments

    Frontier Economics hosted a roundtable discussion at the recent Nuffield Trust Health Policy Summit to discuss the development of economic regulation.

    We drew some (only some – yes, health care is different) inspiration from the experience of other regulators. The early days of Postcomm – the postal regulator overseeing a government-owned Royal Mail – provided some lessons.

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

    6 Feb 2014
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    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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  4. Hard truths or home truths?

    28 Nov 2013
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    It has been a very busy November for the NHS. Hospitals, general practice, community and other services have been battling to deal with the apparently incessant demand for emergency advice and care – a warning sign of how difficult it will be for the service to make it through the winter unscathed.

    How far this pressure is due to constrained funding, the effects of the recession on people’s health and access to social care, growing numbers of frail elderly...

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  5. A new start for the Care Quality Commission?

    12 Aug 2013
    Comments

    Today we publish our response to the Care Quality Commission’s (CQC) consultation on changes to the way it inspects, regulates and monitors care services: A New Start.

    Our response builds on the findings from our review of provider ratings, commissioned by the Secretary of State for Health, as well as drawing on the expertise of various members of our team with a past in regulation.

    ...

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  6. Should there be 'Ofsted-style' ratings for health and social care providers?

    22 Mar 2013
    Comments

    This was the question set by the Secretary of State.

    We’ve been there before, and the added value of previous ratings relative to the costs is not clear either way. Nor indeed is the potential for ratings to have an impact in the future if there were improvements in its design and use.

    So what might ratings add today? There are two obvious gaps.

    First, there is currently no independent comprehensive assessment of quality across all providers and across the full spectrum of performance. Second, there is nothing...

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  7. Mid Staffordshire Public Inquiry: will the public and patient voice be heard?

    6 Feb 2013
    Comments

    Amidst all the shocking evidence about failures of staff, regulators and managers, there's a subplot to the Mid Staffordshire Inquiry that's received less attention. This is the failure of the vehicles supposed to convey patients' voices beyond the hospital, to the local public, patient and representative bodies.

    Evidence to the Inquiry exposed how the arrangements for responding to complaints within the hospitals failed to deliver: many patients complained to PALS (the Patient Advice and...

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  8. Size versus quality? Examining hospital mergers

    (Guest blogger)
    16 Jan 2013
    Comments

    Hospital mergers and reconfiguration are increasingly centre stage in the NHS. Several years of financial austerity, with more in prospect, is placing severe stress on hospital finances. The ability of hospitals to deliver the necessary annual cost reductions (in the order of five per cent per annum) through tactical savings schemes is fast diminishing.

    Instead, more radical options for cost saving are being considered, including merger and major reconfiguration – as evidenced by the Department of Health’...

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  9. The NHS Mandate: liberation or ligature?

    16 Nov 2012
    Comments

    There has been feverish activity at the Department of Health this week to finalise a document that could have profound implications for the direction of the NHS in England.

    The NHS Mandate may not hog the headlines, but it sets out what is expected in return for the tax-funded budget between 2013 and 2015. Ministers are keen to present it as a pioneering document, which takes the NHS into a brave new world and brings the reforms a step closer to reality.

    The novelty lies in the trade off at the heart of the reforms: in exchange for...

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  10. Building a 'liberated' NHS: time to focus on the detail?

    9 Nov 2012
    Comments

    It has been a busy few months for those putting the flesh on the bones of the Health and Social Care Act 2012. Consultation responses have been requested on a wide range of topics, all of them central to the implementation of the coalition Government’s vision of a ‘liberated NHS’.

    Views have been sought on the NHS mandate, the NHS Constitution, Monitor’s draft licensing conditions and accompanying guidance, and the rules governing procurement and competition in the NHS, as well as joint strategic needs...

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  11. Institutional entrepreneurs - it's the information that matters

    2 Oct 2012
    Comments

    There are three requirements for entrepreneurship to flourish: the capacity to invest and innovate; the autonomy to make decisions over resources; and the confidence that the fruits of success can be retained, either by the individual or the enterprise. Of course, these conditions are usually in place in properly functioning conventional markets, allowing entrepreneurs to invest, innovate and reap the rewards of success.

    In a recent Nuffield Trust seminar however,...

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  12. Competition in the NHS: the rules of the game

    5 May 2011
    Comments

    The debate about price competition in the NHS is a very good example of a more general point: the impact of competition in health care will depend on the ‘rules of the game’.

    The Health and Social Care Bill sets out some of the parameters for competition but much of this is of necessity very broad and open to interpretation.  This job of interpretation falls largely to the new economic regulator – Monitor.  Its approach (or regulatory stance in the jargon) will have a profound effect on the way competition evolves over the coming years.

    The market mechanism session of...

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