1. Fact or Fiction? Social care cuts are to blame for the 'crisis' in hospital emergency departments

    29 Jan 2015
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    Rising demand for urgent and emergency care is not a new challenge. But in recent months, there’s been a scramble to find explanations for the overheating hospital sector. Nigel Edwards examines what we do know. 

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  2. Local leaders and MPs must embrace NHS England vision

    23 Oct 2014
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    It’s the report the NHS has been waiting for. 

    Simon Stevens’ vision for the future of how care will be organised and delivered in England is set out in the Five Year Forward View – the first time the arm’s length bodies in the NHS have come together to produce such a report. 

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  3. Party conference commitments on NHS spending: the unanswered questions

    15 Oct 2014
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    I am writing this from my hospital isolation room having just had a stem cell transplant that will I hope cure my dysfunctional bone marrow. The transplant and the care that goes with it is a tremendous fusion of compassion, research, pharmaceutical development, attention to detail, dedicated caring professionalism from the unit director through to the receptionists, significant voluntary sector input largely from the Anthony Nolan Trust but also in funding of hospital facilities, and international cooperation.

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  4. Counting the cost of end of life care

    25 Sep 2014
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    Our health services are not just about our health. They are also heavily involved in our deaths.

    This year, for every 1,000 people in England, nine will die. Eight of those nine will have some hospital care during their final year of life. For four or five, a hospital bed will be their last.

    Unsurprisingly, people who are near to the end of their lives are disproportionately high users of hospital services. We estimate, that approximately 15% of all emergency hospital admissions in England belong to the 1% of people in their final year of life.

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  5. Only half the picture: understanding the impact of the social care squeeze

    11 Jul 2014
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    Yesterday our Into the Red? report revealed worrying signs about the future funding of the NHS in England. This was echoed in the results of our first survey of leading figures from the field of health and social care, with around half of respondents saying they felt it was unlikely that the NHS would be free at the point of use in ten years’ time.

     

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  6. Social care and cancer: tracking care across service boundaries

    (Guest blogger)
    2 Jun 2014
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    A recently published Nuffield trust report offers a fascinating insight into the routes that cancer patients take through the care system. In an era that promotes integrated care we all accept that caring for a person extends beyond one organisation; and treatment for cancer may include primary, community and social care on top of acute hospital activities.

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  7. The other care crisis: disabled people are also feeling the squeeze

    (Guest blogger)
    26 Mar 2014
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    The new report from QualityWatch (a joint research programme from the Nuffield Trust and Health Foundation) is another reminder that the social care system is on its knees.

    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.

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  8. Defining moments of 2013, predictions for 2014

    16 Dec 2013
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    What were your defining moments of 2013 for the NHS? There were several contenders, but for me there were two events that bookended the year.

    The first was the Francis Report published in February. This wasn’t for its monumental nature and vast number of recommendations but it was the moment when quality decisively displaced finance as the overriding imperative for Boards and managers.

    The consequences of this are unfurling from the...

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  9. Reforming social care – the Japanese experience

    (Guest blogger)
    27 Nov 2013
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    How is the oldest population in the world – Japan – coping with the long-term health and social care needs of its population?

    That is the question that a new report published by the Nuffield Trust attempts to answer:Caring for an ageing population: points to consider from reform in Japan.

    I was one of a group who visited Japan as part of this project. In the report we describe how Japan introduced compulsory social care insurance to pay for care in older age.

    Briefly, everyone over the age...

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  10. The quality of care: we must keep watching

    21 Nov 2013
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    This week the Care Quality Commission (CQC) have published their annual report on the state of care. It provides a useful overview of the state of care services in England, and also tells us a little of the state of the regulator too.

    Everyone understands that these are difficult times for care services. The financial constraints introduced in 2010/11 are starting to bite and the NHS is still coming to terms with its recent re-organisation. Many people are worried about the impact this may be having on...

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  11. New century, new hospital

    30 Sep 2013
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    Since the money stopped flowing freely into the NHS, there has been a relentless focus on the hospital. Recent concerns about quality are matched by continuing concern about money.

    They come together in the increasing professional and managerial clamour for reconfiguration as the solution to quality and financial issues, targeting smaller hospitals in the way stranded explorers might look hungrily at their weakest comrade.

    The recent Royal College of...

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  12. A new start for the Care Quality Commission?

    12 Aug 2013
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    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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  13. Long-term care reform in the United States

    (Guest blogger)
    19 Jun 2013
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    Long-term services and support (LTSS) primarily refers to personal care services that include home help, care in nursing homes and assisted living, as well as day care.

    Of the 13 million Americans that need long-term care, only 13 per cent have received help in paying for these services. The situation is set to become even more challenging, as the proportion of Americans over the age of 65 is...

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  14. Do home palliative care services have an impact on where people die?

    (Guest blogger)
    18 Jun 2013
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    As in many other developed countries, the UK population is rapidly ageing. This has implications for the provision of health and social care, as older age and life-limiting, chronic conditions are closely linked. There is a growing need for palliative care.

    One of the key values of palliative care is to enable people to choose where to be cared for at the end of life. When asked for their...

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  15. The 'new' NHS and the emergency care challenge

    (Guest blogger)
    19 Apr 2013
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    This is a critical time for the NHS, with many key themes to discuss. But my start to the year is dominated by emergency care – a very practical challenge but one that raises important questions about culture too.

    Across the NHS we are really struggling with emergency activity. Even allowing for Norovirus and prolonged cold weather we are experiencing unusual pressure.

    The...

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

    22 Mar 2013
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    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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  17. Principles matter: reforming social care funding

    11 Feb 2013
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    There is almost universal agreement that the social care system needs urgent and fundamental reform. Despite this consensus the various attempts at reform over the last 20 years have all stalled.

    Against that background Andrew Dilnot could have been considered either brave or foolhardy to accept the Government’s request to head the latest commission on reforming social care funding in 2010. Last year when it looked like the Government was planning to kick funding reform into the long-grass once again, the evidence pointed towards...

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  18. Mergers, 24/7 working and ratings – mind the gaps

    30 Jan 2013
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    The queasily thin amount of experienced medical cover in some hospitals at nights and weekends was the subject of BBC Radio 4's File on 4 last week. Juniors missing key symptoms and signs, not wanting to bother a consultant out of hours, with occasional tragic results or at best near misses.

    Suggestions for remedy included making consultants work 24/7 rotas. I sympathised with the experienced paediatrician who predicted that would be the last straw for many who have given their all for the NHS over many years.

    The...

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  19. The Chancellor's Autumn Statement: austerity could get worse for the NHS

    13 Dec 2012
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    One thing is clear from the Autumn Statement, the NHS needs to plan for a much longer period of austerity – it’s at least seven years and it could well be a decade.

    The Chancellor has reopened the current Spending Review and taken a further £6.6 billion of public spending to fund an infrastructure investment programme with the aim of supporting economic growth.

    The Autumn Statement certainly confirms that we need economic growth. The Office of Budget...

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  20. Public spending and the NHS: what do the public think?

    (Guest blogger)
    3 Dec 2012
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    It seems that as the focus of the health community moves away from the Health and Social Care Act the debate has begun in earnest about the funding challenge faced by the NHS.

    No one working in the sector is under any illusions about the scale of the Nicholson challenge. The question is where are the public on this?

    Communicating the concept of cuts to the NHS or thinking about how more money could be found is a task no politician would relish – and for good...

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