1. Health care reform: lessons from international experience

    22 Nov 2010
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    The Nuffield Trust recently joined forces with Salzburg Global Seminar and the British Medical Journal to host a global meeting on health system reform. Housed in the magnificent surroundings of Schloss Leopoldskron, Salzburg Global Seminar has been a refuge for thinking and reflection since the Second World War. On this occasion, emerging leaders from 29 countries spanning every stage of economic development, met to discuss the challenges of achieving universal access to high quality health care that is both affordable...

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  2. Understanding the Treasury’s figures for health

    15 Oct 2010
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    It’s less than a week to the long awaited Spending Review.  Across the public services the consolidation plans are unprecedented, culminating in a tightening of £83 billion in 2014-15.  Health, along with overseas development, is in a protected position with the Government promising a real terms increase in funding between 2011-12 and 2014-15. 

    On Wednesday we will know what level that real terms increase will be but it is clear that the headline level will be substantially below the growth of the last decade, when health spending doubled in real terms.  It is...

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  3. Toronto Virtual Ward: useful lessons for NHS hospitals?

    12 Oct 2010
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    Starting in April 2011, NHS hospitals in England will not be paid for “avoidable” readmissions occurring within 30 days of discharge.  As Trust finance officers begin steeling themselves for this change, they may be interested in a Canadian project designed to predict and avoid such readmissions. 

    Known as the Toronto Post-Discharge Virtual Ward, the project borrows a concept first developed...

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  4. Open-source software: could this be the glue that holds the NHS together?

    6 Oct 2010
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    Good news stories don’t come around that often for Connecting for Health, the beleaguered national IT programme for the National Health Service in England.  But I think I might have found one in the making.  This month marks the mid-way point in a two-year project to build an “open-source community” for the NHS. 

    For the uninitiated, open-source software is different from the “closed source” software that...

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  5. Handing real budgets to GPs: is this really the right approach?

    21 Sep 2010
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    Will GP consortia be able to achieve better value care and control costs in the NHS in England? This policy is the centrepiece of health secretary Andrew Lansley’s NHS reforms, and as we go into the autumn it remains the key point of debate (read our briefing on the health White Paper).
     
    Already Stephen Dorrell, former Secretary of State for Health (1995-7) and newly elected chair of the Health Select Committee, is asking the obvious: what is the evidence that GP commissioning will work after 20 years of being largely ineffective? The...

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  6. 11th International meeting on Quality of Health Care

    16 Sep 2010
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    For the past eleven years, senior academics, policy-makers and practitioners from the United States and United Kingdom have met annually to discuss common areas of work relating to the quality of health care. The meetings are held under Chatham House rules which do not permit the direct attribution of comments. What we offer here is a reflection of the main areas of debate and discussion by Nuffield Trust Senior Fellows Vidhya Alakeson and Ruth Thorlby, supplemented by links to relevant articles, blogs and short podcasts with some of the participants.

    It is...

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  7. Broccoli branding, 23-hour clinics, and the bone phone: new lessons from Kaiser Permanente

    2 Aug 2010
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    On 22 July, The Nuffield Trust held the first in our series of seminars focussing on ‘High Value Health Care’, in partnership with the Royal College of Physicians and the Cambridge Health Network.

    Before the seminar began I heard a few mutterings from audience members about how comparisons between Kaiser Permanente and the NHS are so well known that they’re becoming a bit trite. 
     
    However, by the end of Bernard Tyson and Jed Weissberg’s presentations, nobody could be in doubt that the NHS still has...

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  8. GP commissioning viewed from down under

    28 Jul 2010
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    On the day that the Coalition Government published ‘Liberating the NHS: commissioning for patients’, I found myself here in Auckland as a keynote speaker at the joint conference of the Australian General Practice Network and General Practice New Zealand.  These two bodies represent what in this part of the world is known as ‘organised general practice’ or in NHS terminology ‘GP consortia’.
     
    Travelling to the Southern Hemisphere can be disorientating.  Summer is replaced by winter, and the days are suddenly short again.  What is however reassuringly familiar, both...

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  9. Health care reform: UK v US

    26 Jul 2010
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    As the coalition government begins to consult on its radical proposals for NHS reform in England, the boldness of the ideas have begun to be noticed internationally. The ideas contained in the recent White Paper, Equity and Excellence: Liberating the NHS, were the subject of much discussion at a recent meeting of policy-makers and academics in Boston, sponsored by the Nuffield Trust and Commonwealth Fund (check back shortly...

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  10. White Paper proposals for GP commissioning: home thoughts from abroad

    14 Jul 2010
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    As details emerge about the new Coalition Government’s plans to reform the NHS by handing GPs more commissioning power, one thing is certain: this reform is high risk and will need very careful implementation if it is to deliver where others in the UK and overseas have failed.
     
    At the point where NHS funding is about to be squeezed, and commissioners need to drive rapid improvements in efficiency and quality, there is little evidence that GP commissioning can deliver to the extent implied in the White Paper.
     
    Most notably, while a handful of GPs around the country...

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  11. Is there a plan B to integrated care?

    5 Jul 2010
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    Delegates to the recent NHS Confederation conference in Liverpool could be forgiven for thinking that the latest NHS target was to achieve vertical integration as soon as possible. I am talking here not about community services providers being snapped up by Trusts, but about integration between primary, secondary, community and in some cases social care.  ‘If this isn’t it, what is plan B?’ opined a speaker from NHS Manchester.

    It’s true – integration seems to be spreading across England, given huge impetus by the financial challenge. In the absence of much formal evidence of...

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  12. Trends in emergency admissions in England 2004 – 2009: is greater efficiency breeding inefficiency?

    7 May 2010
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    Rates of emergency admissions to hospital have been rising for many years, and if they continue it could prompt major financial problems for the NHS, particularly heading into a period of constrained funding.
     
    Although there is no shortage of opinions and ideas about what underlies this trend, relatively little is actually known about detailed patterns and causes.  
     
    Here at the Nuffield Trust, we have used nationally available routine administrative data to look at the rise in emergency admissions over the past few years.
     
    Our analysis showed that...

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  13. The state we're in: reflections from the Summit

    31 Mar 2010
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    We had an intense think-in at our Annual Health Strategy Summit this week, chewing the cud on the major elements of reform: competition, efficiency and integrated care.
     
    Will Hutton, Chair of The Work Foundation, blew everyone away on Budget Day with an intellectual tour de force on ‘the state we’re in’ and why the health sector is part of the solution to growth.
     
    In the future, he thought it near inevitable that some form of top-up insurance would be needed for those able to pay for benefits on top of the NHS offer; ‘flexi-security’ of jobs...

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  14. Where next for commissioning and integrated care: can the NHS rise to the challenge?

    18 Mar 2010
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    At a recent joint Nuffield Trust and King’s Fund conference, everyone was agreed that there is a pressing need to transform the way in which health care services are delivered in the NHS, given the straitened financial times that now loom large.
     
    These tougher financial times, taken together with rising incidence of chronic disease among an ageing population, call for new forms of community-focused care that will tackle ill-health upstream, provide intensive support in people’s own homes, and seek to prevent unnecessary and costly...

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  15. Lies, damned lies and statistics

    27 Jan 2010
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    As the old saying goes, there are lies, damned lies and statistics. The major comparative analysis of the performance of the NHS across the four countries of the UK that we published last week brought this into sharp focus.
     
    While there has been much debate and consternation over the accuracy of one particular figure for the NHS in Scotland – and bear in mind this was an official figure published by the Office for National Statistics that has been in the public domain for three years – what these discussions have shown is the fundamental...

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  16. Integration: the past or the future?

    25 Nov 2009
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    All talk in the NHS is of the big financial challenge ahead. Using that challenge to accelerate development of the NHS rather than set it back will be critical. In the short term bigger than usual reductions of hospital beds, pay restraint and staff reductions, in particular cut backs in managerial costs, and economies in supplies must be on the cards. Done well that will take a lot of effort, but it will not be nearly enough.

    What is needed is change that will set the NHS on a better path for the future, in which short run economic misery will give way to medium and longer term...

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