Rationing in the NHS – Nuffield Trust – 19 February 2015

Posted on February 19, 2015. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Rationing in the NHS – Nuffield Trust – 19 February 2015

Media release: ‘Messy’ approach to rationing healthcare losing legitimacy: New Nuffield Trust analysis – Nuffield Trust – 19 February 2015

 

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Hospital admissions from care homes – Nuffield Trust Quality Watch – 29 January 2015

Posted on January 30, 2015. Filed under: Aged Care / Geriatrics | Tags: , |

Hospital admissions from care homes – Nuffield Trust Quality Watch – 29 January 2015

“Our analysis explores how care home residents use hospital services, and how this information could prompt improvement in the way care is provided.”

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Now or Never: Shaping Pharmacy for the Future – Nuffield Trust for the Royal Pharmaceutical Society (RPS) – 10 December 2014

Posted on December 10, 2014. Filed under: Pharmacy | Tags: , |

Now or Never: Shaping Pharmacy for the Future – Nuffield Trust for the Royal Pharmaceutical Society (RPS) – 10 December 2014

“In 2013 the RPS established a Commission on Future Models of Care Delivered Through Pharmacy. The commission’s report, Now or Never: Shaping Pharmacy for the Future, urged the RPS to take the lead in enabling pharmacists in England to take on roles in patient care.

The RPS accepted this accountable role, and followed the recommendation in Now or Never by commissioning an independent review from the Nuffield Trust to assess progress towards achieving the report’s vision.

Now More Than Ever: Why Pharmacy Needs to Act sets out the findings from this review. It comes soon after NHS England’s Five Year Forward View created broader opportunities for pharmacists than ever before, opening the door for them to provide frontline urgent and out-of hours care services, and work as part of new GP federations.”

… continues on the site

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Posted on October 14, 2014. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , , |

Cause for concern: second annual statement – Quality Watch, The Health Foundation & Nuffield Trust – 10 October 2014

“Our second annual statement, Cause for concern, offers an independent assessment of the current quality of NHS health and social care services in England. We observe that while care quality has improved since a decade ago, the last year has seen progress in some areas slow down or begin to reverse.”

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NHS hospitals under pressure: trends in acute activity up to 2022 – Nuffield Trust – 6 October 2014

Posted on October 7, 2014. Filed under: Acute Care, Health Mgmt Policy Planning | Tags: , |

NHS hospitals under pressure: trends in acute activity up to 2022 – Nuffield Trust – 6 October 2014 “In this analysis we look at trends in admissions and bed use over the last few years, and use population projections to explore the likely pressures on hospitals in the future.”

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Focus on: A&E attendances – why are patients waiting longer? – QualityWatch – The Health Foundation & Nuffield Trust – July 2014

Posted on July 25, 2014. Filed under: Emergency Medicine | Tags: , |

Focus on: A&E attendances – why are patients waiting longer? – QualityWatch – The Health Foundation & Nuffield Trust – July 2014

Web page for the report

“Accident and emergency departments are facing unprecedented demand and making headlines by missing the high profile four-hour waiting time target. Our in-depth study looks at patterns of A&E activity, the nature of the increased demand and what has driven waiting times upwards.”

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Into the Red? The State of the NHS’ Finances – Nuffield Trust – 10 July 2014

Posted on July 11, 2014. Filed under: Health Economics | Tags: , |

Into the Red? The State of the NHS’ Finances – Nuffield Trust – 10 July 2014

“This report shows that, after holding up well under austerity since 2010, the NHS’ finances are starting to come under severe financial pressure.”

 

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Meeting need or fuelling unnecessary demand? Understanding the impact of improved access to primary care – Nuffield Trust – 30 June 2014

Posted on July 1, 2014. Filed under: General Practice | Tags: |

Meeting need or fuelling unnecessary demand? Understanding the impact of improved access to primary care – Nuffield Trust – 30 June 2014

“Meeting Need or Fuelling Demand? Improved access to primary care and supply-induced demand examines how far increased access to general practice and other primary care services will deal with unmet need, or whether these efforts may only serve to stimulate additional use of services that would not have otherwise occurred.”

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Use of health and social care by people with cancer – Nuffield Trust – 2 June 2014

Posted on June 3, 2014. Filed under: Oncology, Social Work | Tags: |

Use of health and social care by people with cancer – Nuffield Trust – 2 June 2014

“This report presents the results of our study into the primary, secondary and social care use of people diagnosed with cancer.

Summary

There are estimated to be around two million people living with cancer in the UK. Improved survival rates, earlier detection and an ageing population have led to cancer incidence increasing, but it is now seen as a chronic condition rather than necessarily a fatal illness. This shift has led to a growing focus on survivorship, and on the long-term needs of those living with and after cancer.

To find out how this impacts on the use of health and social care services, we used data linkage methods to track the patterns of service use across health and social care in the year after people were diagnosed with cancer.”

… continues on the site

 

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The four health systems of the UK: How do they compare? – Nuffield Trust – 11 April 2014

Posted on April 14, 2014. Filed under: Comparative Effectiveness Research, Health Mgmt Policy Planning, Health Policy, Health Systems Improvement | Tags: |

The four health systems of the UK: How do they compare? – Nuffield Trust – 11 April 2014

“This report, published by the Nuffield Trust and the Health Foundation, assesses the performance of the NHS on the quality of patient care in all four UK countries since devolution.

Summary

Since political devolution in 1999, there has been increasing policy divergence between the health systems of the four countries of the United Kingdom (UK). This report attempts to update earlier comparisons of the publicly financed health systems of England, Scotland, Wales and Northern Ireland in terms of funding, inputs and performance before and since devolution.

It also includes comparisons with the North East of England, which has been chosen as a better comparator with the three devolved nations than England as a whole.”

… continues on the site

 

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Social care for older people – The Health Foundation and Nuffield Trust – 26 March 2014

Posted on March 27, 2014. Filed under: Aged Care / Geriatrics, Health Economics | Tags: , |

Social care for older people – The Health Foundation and Nuffield Trust – 26 March 2014

“Budget allocations from central Government to English local authorities were reduced by 14% in real terms between 2011/12 and 2014/15. This report asks how local authorities have responded to this decline in income and explores the possible impact on older adults’ health and wellbeing.”

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NHS payment reform: lessons from the past and directions for the future – Nuffield Trust – 20 February 2014

Posted on February 21, 2014. Filed under: Health Economics | Tags: |

NHS payment reform: lessons from the past and directions for the future – Nuffield Trust – 20 February 2014

“This policy response reviews different approaches to payment for health services in the English NHS. It explores the evidence on whether recent payment initiatives have met their goals.

The health service has historically been a leader among public services in embracing innovation in payment systems. A wide range of different approaches to payment are now in place for different sectors and different areas, often introduced specifically to drive quality, volume or productivity improvements.

If the NHS is to improve the efficiency of the health system as a whole, it needs payment systems that cover the continuum of care and which create incentives for providing the ‘right care in the right setting’
Anita Charlesworth, Chief Economist, Nuffield Trust and co-author

This policy response looks at options for development of the payment reform system in England. It recommends that any changes are targeted on where they are likely to have the greatest impact, and aligned with wider system changes. The authors also call for any changes to be transparent and evidence-based, as well as predictable and credible.

This policy response is published alongside a research report, The NHS payment system: evolving policy and emerging evidence, which looks at the evidence on whether recent payment initiatives have met their goals.”

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Distance from home for emergency care [UK] – Quality Watch – February 2014

Posted on February 19, 2014. Filed under: Emergency Medicine | Tags: , |

Distance from home for emergency care [UK] – Quality Watch – February 2014

“How far away from home do people receive their emergency care, and how has this changed over the past decade? It is important that we have a clear picture of the distances involved in accessing emergency care in order to understand the impact of changes in hospital and A&E locations.”

Report –  developed in partnership by the Nuffield Trust and the Health Foundation

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The Francis Report one year on – Nuffield Trust – 6 February 2014

Posted on February 6, 2014. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: , |

 

The Francis Report one year on – Nuffield Trust – 6 February 2014

 

“Summary

 

To mark the first anniversary of the publication of the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (the Francis Inquiry), the Nuffield Trust has published a new piece of research exploring its impact.

 

This study has been published to coincide with an event hosted by the Trust on 6 February 2014, exactly a year after the Francis Inquiry reported.

 

The study offers a snapshot into how acute trusts have responded to the Francis Inquiry Report. It is aimed at policy-makers, national statutory bodies, acute trusts, health representative groups and trade unions, patient groups and charities, and health service commissioners. Robert Francis QC, who acted as an adviser to the research, has written a foreword to the study.”

 

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Caring for an ageing population: points to consider from reform in Japan – Nuffield Trust – 27 November 2013

Posted on November 28, 2013. Filed under: Aged Care / Geriatrics, Health Policy | Tags: , |

Caring for an ageing population: points to consider from reform in Japan – Nuffield Trust – 27 November 2013

“Summary

Changing demography and the rising prevalence of long-term conditions has meant that finding a sustainable and fair model of funding social care for our growing older population is a matter of significant policy attention in England.

Japan has the oldest population in the world with 23 per cent of its population aged over 65; this is set to rise to 40 per cent by 2050. In order to address the shortage of social care, to ease burdens on informal carers and to relieve pressure on health services, a new insurance system for long-term care was introduced in Japan in 2000.”

… continues on the site

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Managing financial difficulties in health economies: lessons for clinical commissioning groups – Nuffield Trust – 17 October 2013

Posted on October 17, 2013. Filed under: Health Economics | Tags: |

Managing financial difficulties in health economies: lessons for clinical commissioning groups – Nuffield Trust – 17 October 2013

This report examines why some health economies have been more successful than others in balancing their finances and outlines some key lessons for clinical commissioning groups.”

 

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Personal health budgets: challenges for commissioners and policy-makers – Nuffield Trust – August 2013

Posted on August 29, 2013. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: , |

Personal health budgets: challenges for commissioners and policy-makers – Nuffield Trust – August 2013

“A personal health budget is an allocation of NHS money to someone with an identified health need so that they can buy the services they think will improve certain aspects of their health and wellbeing. It is intended to give the recipient more control over the care that they receive.

In 2009 the Department of Health launched a pilot programme to look at the viability of personal health budgets and an independent evaluation was carried out. It was found that they have a positive impact on care-related quality of life and wellbeing and are cost-effective. It was recommended that they should have a wider roll-out. The Government has since committed that from April 2014 everyone who receives NHS continuing health care funding will have a right to request a personal health budget rather than receiving commissioned services. This will present issues and challenges for commissioners and policy-makers.

In this research summary we describe what personal health budgets are and how they are supposed to work in practice. We also look at the evidence from the national evaluation and explore some of the issues that will be raised for commissioners and policy-makers as personal health budgets are rolled out.”

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Spending on health and social care to 2015-16 [Parliamentary Briefing] – Nuffield Trust – 11 July 2013

Posted on July 24, 2013. Filed under: Health Informatics | Tags: , |

Spending on health and social care to 2015-16 [Parliamentary Briefing] – Nuffield Trust – 11 July 2013

“This briefing examines the key issues underlying debates on health funding, the decisions taken on NHS spending over this Parliament and the 2015-16 Spending Round period, and the closely linked issue of spending on social care.

It aims to link these fiscal decisions to their implications for access, quality, sustainability and efficiency.

The first section of the briefing examines how spending in the NHS faces upward pressure from internal factors at the same time as its budget is under downward pressures from outside, leading to a gap.

The second looks at how the Government is trying to bridge this gap and how deeper changes may be needed to achieve a long-term solution, while the third looks at the urgent situation facing social care funding in the context of the reforms contained in the Spending Round and Care Bill.”

 

 

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Clinical commissioning groups: Supporting improvement in general practice? – The King’s Fund and the Nuffield Trust – 22 July 2013

Posted on July 24, 2013. Filed under: General Practice | Tags: , |

Clinical commissioning groups: Supporting improvement in general practice? – The King’s Fund and the Nuffield Trust – 22 July 2013

“Introduction

Clinical commissioning groups (CCGs) are one of the main components of the government’s reforms to the health and social care system. In April 2013, these newly established, clinically led organisations replaced primary care trusts as the commissioners of most services funded by the National Health Service (NHS) in England, and now control around two-thirds of the NHS budget. All general practices in England are now legally obliged to be a member of a CCG. The intention is to encourage clinicians to play a greater role in deciding how funds are spent in order to shape services to meet local needs.

CCGs have two important, but distinct, roles: they are responsible for commissioning secondary and community care services for their local populations; and they have a legal duty to support quality improvement in general practice. This second role has received less attention to date, but is vitally important if CCGs are to achieve their wider objectives and deliver more integrated forms of care. It will, however, be a challenging role for them to fulfil, particularly as general practitioner (GP) services are commissioned by NHS England.

About this research

The King’s Fund and the Nuffield Trust are working together over a three-year period to assess the implementation and impact of CCGs. We are examining clinical commissioning in six case study sites between 2012 and 2015, focusing on:
. the nature of relationships being built inside CCGs, particularly the interface with member practices and the extent of GP involvement in CCG activities
. the role of CCGs in supporting quality improvement in general practice
. the structures and processes through which these relationships and improvement activities are conducted.”

… continues

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Securing the future of general practice: new models of primary care – The King’s Fund and the Nuffield Trust – 18 July 2013

Posted on July 24, 2013. Filed under: General Practice, Primary Hlth Care | Tags: , , |

Securing the future of general practice: new models of primary care – The King’s Fund and the Nuffield Trust – 18 July 2013

“This report from the Nuffield Trust and The King’s Fund examines the new GP organisations forming to allow care provision at greater scale.”

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The wisdom of the crowd: 65 views of the NHS at 65 – Nuffield Trust – July 2013

Posted on July 5, 2013. Filed under: Health Mgmt Policy Planning | Tags: , |

The wisdom of the crowd: 65 views of the NHS at 65 – Nuffield Trust – July 2013

“On 5 July 2013, the NHS reached its 65th anniversary. To mark this milestone, the Nuffield Trust has been carrying out a number of activities to promote debate and discussion on the current state of the NHS and social care system, and its future prospects.

This publication is the centrepiece of our activities. Enclosed are interviews and essays with a cast list of 65 health and political leaders, consisting of current and former health secretaries and ministers, senior civil servants, clinicians, managers, academics, patient representatives, journalists and other key individuals. It is edited by Nuffield Trust Senior Associate Nick Timmins, who has reprised a role he performed for the Nuffield Trust back in 2008 when we took a similar temperature check of the views of leaders at the time of the NHS’s 60th anniversary.”

… continues

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The view from Westminster: Parliamentarians on the future of health and social care – Nuffield Trust – June 2013

Posted on June 21, 2013. Filed under: Health Policy | Tags: |

The view from Westminster: Parliamentarians on the future of health and social care – Nuffield Trust – June 2013

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Public payment and private provision: the changing landscape of health care in the 2000s – Nuffield Trust – 22 May 2013

Posted on May 31, 2013. Filed under: Health Economics | Tags: |

Public payment and private provision: the changing landscape of health care in the 2000s – Nuffield Trust – 22 May 2013

“A report from the Institute for Fiscal Studies and the Nuffield Trust examining the changing relationship between the public and private sector in the provision of NHS funded care in the past decade.”

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Evaluation of the first year of the Inner North West London Integrated Care Pilot – Nuffield Trust – 17 May 2013

Posted on May 20, 2013. Filed under: Aged Care / Geriatrics, Chronic Disease Mgmt | Tags: , |

Evaluation of the first year of the Inner North West London Integrated Care Pilot – Nuffield Trust – 17 May 2013

“This report outlines the findings of our evaluation of the Inner North West London Integrated Care Pilot, which aimed to develop new forms of care for older people and those with diabetes.”

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Reclaiming a population health perspective – Nuffield Trust – April 2013

Posted on April 26, 2013. Filed under: General Practice, Public Hlth & Hlth Promotion | Tags: |

Reclaiming a population health perspective – Nuffield Trust – April 2013

“The report, which was written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC), examines the arguments for encouraging and enabling general practices to take a much more proactive role in improving the health and wellbeing of their local populations, as well as their individual patients.

It also draws on analysis of routine data from a notional general practice of 10,000 patients and a series of interviews conducted with GPs and practice managers who are participating in the NAPC’s newly-established Practice Innovation Network, which brings together staff from GP practices to develop and test out new approaches to population health management.”

… continues on the site

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NHS in numbers: key charts – Nuffield Trust – April 2013

Posted on April 17, 2013. Filed under: Health Mgmt Policy Planning | Tags: , , , |

NHS in numbers: key charts – Nuffield Trust – April 2013

“This series of interactive charts illustrates key data on health care spending, hospital activity, performance, prescribing, and NHS staffing and other resources, for England and the rest of the UK where comparable data is available.”

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Rating providers for quality: a policy worth pursuing? – Nuffield Trust – 22 March 2013

Posted on March 25, 2013. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: |

Rating providers for quality: a policy worth pursuing? – Nuffield Trust – 22 March 2013

“The Nuffield Trust was commissioned by the Secretary of State for Health to review whether ratings of provider performance should be used in health and social care. This report outlines the findings.

Should there be ‘Ofsted-style’ ratings for health and social care providers such as hospitals, GP practices and care homes?”

… continues

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The Francis Public Inquiry Report: a response – Nuffield Trust – March 2013

Posted on March 15, 2013. Filed under: Patient Safety | Tags: |

The Francis Public Inquiry Report: a response – Nuffield Trust – March 2013

“This Nuffield Trust policy response offers an analysis of several key themes from the Francis report where the Trust has expertise including funding, patient-level data, commissioning and regulation.

Following a public inquiry, on 6 February 2013 Robert Francis QC published his report into failings at The Mid Staffordshire NHS Foundation Trust. This Nuffield Trust policy response analyses several of the recommendations and key themes.”

… continues

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Commissioning high quality care for people with long term conditions – an action research study – Nuffield Trust – March 2013

Posted on March 5, 2013. Filed under: Chronic Disease Mgmt | Tags: , |

Commissioning high quality care for people with long term conditions – an action research study – Nuffield Trust – March 2013

NHS Institute for Health Research funded work

“This project explores how services for people living with long-term conditions (e.g. asthma, diabetes and high blood pressure) can be planned, funded and put in place (commissioned) so that the quality of those services is as high as possible. The research takes as its starting point the fact that there is ample evidence about how, in theory, health services should be commissioned.  This study wishes to focus instead on the practical day-to-day experience of doctors, managers, user and carer representatives and others within primary care trusts who are responsible for working together to commission long-term condition services.”  … continues

Commissioning brief
Executive summary
Final report 
Protocol
Nuffield Trust Research Summary

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A decade of austerity? The funding pressures facing the NHS from 2010/11 to 2021/22 – Nuffield Trust – 3 December 2012

Posted on December 4, 2012. Filed under: Health Economics | Tags: , |

A decade of austerity? The funding pressures facing the NHS from 2010/11 to 2021/22 – Nuffield Trust – 3 December 2012

“This research highlights the funding challenges facing the NHS and social care system in England over the next decade, with NHS funding growth likely to be restricted beyond 2015.”

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Choosing the place of care: The effect of patient choice on treatment location in England, 2003-2011 – Nuffield Trust – 19 November 2012

Posted on November 20, 2012. Filed under: Patient Participation | Tags: |

Choosing the place of care: The effect of patient choice on treatment location in England, 2003-2011 – Nuffield Trust – 19 November 2012

“This report by the Institute for Fiscal Studies (IFS), commissioned by the Nuffield Trust, examines the effect of patient choice and the independent sector on treatment location in England.”

 

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Understanding patterns of health and social care at the end of life – Nuffield Trust – 16 October 2012

Posted on October 17, 2012. Filed under: Palliative Care, Social Work | Tags: |

Understanding patterns of health and social care at the end of life – Nuffield Trust – 16 October 2012

“This report details the key findings from a study of over 73,000 people in England during the last 12 months of their lives. It suggests that social care may help prevent hospital admission.”

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Primary care for the 21st century: learning from New Zealand’s independent practitioner associations – Nuffield Trust – 26 September 2012

Posted on September 27, 2012. Filed under: Primary Hlth Care | Tags: |

Primary care for the 21st century: learning from New Zealand’s independent practitioner associations – Nuffield Trust – 26 September 2012

“As the English NHS prepares to give GPs a leading role in planning and purchasing local health services, this report offers insights from the experience of organised general practice in New Zealand.

Over the past two decades, many GPs and other primary care clinicians in New Zealand have worked collaboratively in independent practitioner associations (IPAs). These networks of primary care providers developed in the early 1990s from the grassroots of general practice.

Although IPAs have not held budgets on the scale of that planned for clinical commissioning groups (CCGs) in England under the Health and Social Care Act 2012, they nevertheless demonstrate the significant potential of organised general practice to enable innovation and expansion in the local provision of care, and to help in the development of more integrated services.”

… continues on the site

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Patient-level costing: can it yield efficiency savings? – Nuffield Trust – 20 September 2012

Posted on September 21, 2012. Filed under: Health Economics | Tags: , |

Patient-level costing: can it yield efficiency savings? – Nuffield Trust – 20 September 2012

“This report examines how, in an era of financial challenge, NHS trusts can make better use of cost information at the patient level, as the first step towards greater efficiency.

Summary

The challenge faced by the NHS of achieving major efficiency savings (estimated at around four to five per cent a year between now and 2015) highlights the desirability of improving the availability and scrutiny of data on the costs and outcomes of health care.

Patient-level costing systems (or ‘PLICS’) were introduced in the NHS in the mid-2000s. The Nuffield Trust research summary: Patient-level costing: can it yield efficiency savings? highlights the key findings of a full report looking at the use of these computerised information systems in hospitals that were set up to track and enable analysis of the costs of care incurred by individual patients.

The report examines whether the implementation of information systems for patient-level costing might lead to greater efficiencies.

Specifically, the study examines how trusts are using and planning to use patient-level costing systems, drawing on the experiences of several early adopters. It also draws an empirical analysis of data from one trust that is more advanced than most in its use of patient-level costing.

The study found that costs to the hospital can be very different from the price they receive for care, with only 17 per cent of cases within 10 per cent of the NHS tariff cost. It also found costly variations of care procedures for similar cases within trusts, and a ‘clustering’ of costs around a small minority of patients; both of these offer the potential for service redesign and potential cost savings.”

… continues on the site

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Reforming payment for health care in Europe to achieve better value – Nuffield Trust – 23 August 2012

Posted on August 24, 2012. Filed under: Health Economics | Tags: |

Reforming payment for health care in Europe to achieve better value – Nuffield Trust – 23 August 2012

“This Nuffield Trust report, supported by KPMG, compares different payment systems for health care used across Europe and examines their role in improving the efficiency and quality of care.

The authors conclude that, while payment systems are an important tool for policy-makers, they should be seen as part of a basket of measures for maximising efficiency and effectiveness that also includes professional culture, public attitudes, and the legal and regulatory framework. Therefore, changes to payment systems need to be part of a wider programme of reform.”

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Reforming social care: options for funding [UK] – Nuffield Trust – 29 May 2012

Posted on May 30, 2012. Filed under: Social Work | Tags: , |

Reforming social care: options for funding [UK] – Nuffield Trust – 29 May 2012

Policy response
by Anita Charlesworth and Ruth Thorlby

“The Government is expected to publish a White Paper on the future of social care in 2012. The White Paper will set out the  Government’s response to the recommendations from the Law Commission on reform of adult social care legislation (Law Commission, 2011) and the Dilnot Commission review of funding for adult social care (Commission on Funding of Care and Support, 2011). There is a risk that reform of funding will be neglected: the forthcoming White Paper is expected to include proposals for the reform of adult social care following the Law Commission’s report on modernising the legislative framework, but the Government has only committed itself to ‘a progress report on funding reform’ (Lansley, 2011). This paper examines the current level of funding of social care and the Dilnot Commission’s recommendations and suggests ways of funding a fairer, more sustainable system of social care.”

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Care home residents least likely to be hospitalised – Nuffield Trust – 29 March 2012

Posted on April 2, 2012. Filed under: Health Mgmt Policy Planning | Tags: , |

Care home residents least likely to be hospitalised – Nuffield Trust – 29 March 2012

“A new study by the Nuffield Trust linking the normally separate health and social care records of more than 133,055 people – aged 75 and over – has found that local authority funded care home residents had fewer hospital admissions than those receiving high intensity social care support in their own homes.

The results lend further support to the argument that cuts to social care budgets may lead to increased hospital admissions.

Writing for the Journal of Health Services Research and Policy, the analysts describe how their methods allow researchers to examine interactions between the two systems of care at the individual patient level. The study is believed to be the largest of its kind in the UK so far.”

… continues

Overlap of hospital use and social care in older people in England
Martin Bardsley et al
J Health Serv Res Policy 23 February 2012

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Rationing health care: is it time to set out more clearly what is funded by the NHS? – Nuffield Trust – 27 February 2012

Posted on February 28, 2012. Filed under: Health Mgmt Policy Planning | Tags: , |

Rationing health care: is it time to set out more clearly what is funded by the NHS? – Nuffield Trust – 27 February 2012

…”Rationing health care: is it time to set out clearly what is funded by the NHS? by Dr Benedict Rumbold, Vidhya Alakeson and Professor Peter Smith, examines both the feasibility, and the advantages and disadvantages, of setting out explicitly the care patients are entitled to, in the form of a nationally specified NHS ‘benefits package’.

It draws on the experience of countries that have sought to explicitly define the health care benefits that their publicly-funded health systems will pay for.

The report outlines the current system in which decisions for determining which treatments are funded by the NHS are arrived at implicitly. It makes several recommendations for how the system could be improved. These include:

Establishing a set of principles that would shape how public money is spent in the NHS;
Producing a national list of the treatments that public money should not be spent on in the NHS (unless there are exceptional circumstances);
Ensuring that decision-making by clinical commissioning groups is transparent.”

… continues on the site

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Can NHS hospitals do more with less? – Nuffield Trust – 12 January 2012

Posted on January 13, 2012. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: , , |

Can NHS hospitals do more with less? – Nuffield Trust – 12 January 2012

“The NHS is facing a period of financial constraint, with providers charged with delivering four per cent efficiency savings per year up until 2015. While this can be seen as an opportunity to stimulate NHS providers to think differently about how they work to deliver services and to extract the necessary efficiencies, the scale of the challenge is unprecedented.

Against this backdrop, the Nuffield Trust commissioned a study into the factors known to impact on hospital efficiency. The resulting report, Can NHS hospitals do more with less?, by Jeremy Hurst and Sally Williams, draws on a review of UK and international research studies and a survey of senior managers and clinicians at NHS trusts.

The report contains recommendations on how hospitals can increase efficiency. It identifies the key determinants of technical efficiency in hospitals, which include: leadership, management and staff engagement; technology adoption; hospital operational processes; staff productivity; and the external policy environment.”

… continues

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Integrated care for patients and populations: Improving outcomes by working together – King’s Fund – 5 January 2012

Posted on January 6, 2012. Filed under: Health Mgmt Policy Planning | Tags: , |

Integrated care for patients and populations: Improving outcomes by working together – King’s Fund – 5 January 2012

A report to the Department of Health and the NHS Future Forum

by Nick Goodwin, Judith Smith, Alisha Davies, Claire Perry, Rebecca Rosen, Anna Dixon, Jennifer Dixon, Chris Ham

“Summary

Integrated care is essential to meet the needs of the ageing population, transform the way that care is provided for people with long-term conditions and enable people with complex needs to live healthy, fulfilling, independent lives. In its June 2011 summary report, the NHS Future Forum stated: ‘we need to move beyond arguing for integration to making it happen’.

The NHS Future Forum’s report built on the ideas that The King’s Fund and the Nuffield Trust presented as part of the government’s listening exercise on the Health and Social Care Bill.

In response, the Department of Health approached The King’s Fund and Nuffield Trust for help in supporting the development of its national strategy on integrated care and to feed ideas directly into the ongoing work of the NHS Future Forum.

Our resulting report examines:

the case for integrated care
what current barriers to integrated care need to be overcome and how
what the Department of Health can do to provide a supporting framework to enable integrated care to flourish
options for practical and technical support to those implementing integrated care, including approaches to evaluating its impact.”

… continues on the site

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Competition, integration and incentives: the quest for efficiency in the English NHS – Nuffield Trust – December 2011

Posted on December 15, 2011. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Competition, integration and incentives: the quest for efficiency in the English NHS – Nuffield Trust – December 2011
by Professor Alan Garber

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Person-based Resource Allocation (PBRA) – Nuffield Trust – 9 December 2011

Posted on December 12, 2011. Filed under: General Practice, Health Economics | Tags: |

Person-based Resource Allocation (PBRA) – Nuffield Trust – 9 December 2011

New approaches to estimating commissioning budgets for GP practices

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Choosing a predictive risk model: a guide for commissioners in England – Nuffield Trust – November 2011

Posted on November 21, 2011. Filed under: Chronic Disease Mgmt | Tags: |

Choosing a predictive risk model: a guide for commissioners in England – Nuffield Trust – November 2011

“Key points
 Predictive risk models are used for predicting events such as unplanned hospital admissions, which are undesirable, costly and potentially preventable.
 Such models have been shown to be superior to other ‘case finding’ approaches, including threshold models and clinical opinion.
 Although the Department of Health has previously funded two predictive models for the NHS in England, the current policy is to promote an open market in terms of suppliers of risk tools.
 Commissioners should consider a range of factors when choosing whether to ‘make or buy’ a predictive model, including the outcome to be predicted, the accuracy of the predictions made, the cost of the model and its software, and the availability of the data on which the model is run.
 Predictive models should be seen as one component of a wider strategy for managing patients with chronic illness.
 Although there are opportunities here for improving the health status of patients with complex needs while making net savings for the NHS, the evidence for hospital-avoidance interventions is patchy and therefore robust evaluations should be built into any proposed local strategies.
 In the future, it is unclear whether predictive risk models in England should best be procured or built at a local, regional or national level.”

… continues on the site

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Towards integrated care in Trafford – Nuffield Trust – 10 November 2011

Posted on November 11, 2011. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , |

Towards integrated care in Trafford – Nuffield Trust – 10 November 2011

by Dr Sara Shaw and Ros Levenson

“This study of efforts in Trafford, Greater Manchester, to deliver integrated care provides valuable insights into the challenge of service reconfiguration at a time of financial constraint.”

… continues

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Managing health reform through an economic downturn – Nuffield Trust – 20 October 2011

Posted on October 21, 2011. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

Managing health reform through an economic downturn – Nuffield Trust – 20 October 2011

“A study of the Canadian experience of managing health reform in a time of austerity suggests that this requires skilful political leadership and honesty with the public about the need for cuts.

In the 1990s, following an economic recession, many provincial Governments in Canada cut their health budgets while also implementing structural reform. To learn from Canada’s experience, the Nuffield Trust and the Canadian Health Services Research Foundation (CHSRF) held a joint seminar, which heard first-hand accounts from senior Canadian politicians, academics and policy-makers, and explored how Canada undertook major reforms to health services in the midst of a severe economic downturn.

Managing health reform through an economic downturn: Canada’s experience with deficit reduction, told through case studies of two provinces, by Nuffield Trust Senior Fellow Ruth Thorlby, is based on the presentations and discussions held at the seminar. It gives an account of the cost-saving measures that politicians and officials from Ontario and Saskatchewan implemented in response to Canada’s falling GDP (national income) at the beginning of the 1990s.”

… continues

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Commissioning integrated care in a liberated NHS – Nuffied Trust – 22 September 2011

Posted on October 19, 2011. Filed under: Health Mgmt Policy Planning | Tags: |

Commissioning integrated care in a liberated NHS – Nuffied Trust – 22 September 2011

“The coalition Government’s NHS reforms provide a renewed emphasis on integrated care. This report explores how commissioners can play a key role in developing more joined-up and efficient services.”

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Setting priorities in health: a study of English primary care trusts – Nuffield Trust – September 2011

Posted on September 27, 2011. Filed under: Health Mgmt Policy Planning | Tags: |

Setting priorities in health: a study of English primary care trusts – Nuffield Trust – September 2011

Research report by Suzanne Robinson, Helen Dickinson, Iestyn Williams, Tim Freeman, Benedict Rumbold and Katie Spence, Health Services Management Centre, University of Birmingham and the Nuffield Trust

Extract from the executive summary
“Aims
The research reported in this document was designed to map the priority-setting activities taking place across the National Health Service (NHS) in England, and to explore and assess the effectiveness of these practices within specific local contexts.
The questions that provided the basis for the research were as follows:
• What priority-setting tools, processes and activities are practised currently as part of the commissioning processes of English primary care trusts (PCTs)?
• What barriers are experienced by PCTs seeking to implement explicit priority setting, and how are these being addressed?
• What other strengths and weaknesses can be identified in current priority-
setting practice?
• What learning can be derived that will be instructive for future priority setting within the NHS and elsewhere?”

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NHS reforms in England: managing the transition – Nuffield Trust – 9 March 2011

Posted on March 18, 2011. Filed under: Health Mgmt Policy Planning, Health Policy | Tags: , |

NHS reforms in England: managing the transition – Nuffield Trust – 9 March 2011

Author: Judith Smith & Anita Charlesworth

“The period from 2011 to 2014 is likely to be the most challenging ever faced by the NHS. Primary Care Trusts (PCTs) are required to hold 2 per cent of their allocations with Strategic Health Authorities (SHAs). Allowing for this, the recurrent resources available to PCTs to spend in 2011/12 fall by 2.3 per cent on average in real terms, with a minimum cut of 0.3 per cent and some PCTs facing a reduction of 2.5 per cent. Providers face the challenge of making a 4 per cent overall efficiency saving at the same time as they experience a 1.5 per cent cut to the tariff by which they are paid.

This Nuffield Trust policy response assesses the 2011/12 Operating Framework for the NHS together with guidance on the operation of Payment by Results (PbR) in 2011/12. It sets out the key challenges associated with managing the transition to a reformed NHS, as envisaged in the White Paper: Equity and Excellence: Liberating the NHS, and proposes ways in which the risks associated with transition might be mitigated.”  … continues on the site

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An evaluation of the impact of community-based interventions on hospital use: a case study of eight Partnership for Older People Projects (POPP) – Nuffield Trust – 10 March 2011

Posted on March 18, 2011. Filed under: Aged Care / Geriatrics, Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

An evaluation of the impact of community-based interventions on hospital use: a case study of eight Partnership for Older People Projects (POPP) – Nuffield Trust – 10 March 2011
Author: Adam Steventon, Martin Bardsley, John Billings, & Geraint Lewis

“To improve the quality of care and at the same time reduce costs, efforts are being made across the UK to deliver more health and social care in community settings. One recent initiative to address this issue was the Partnership for Older People Projects (POPP) – a series of innovative projects that received ring-fenced funding from the Department of Health over a two-year period.

The Nuffield Trust was commissioned by the Department of Health to evaluate a small but carefully selected set of eight POPP interventions and examine whether these interventions were successful at preventing unplanned hospital admissions.”  …continues on the site

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GP commissioning: insights from medical groups in the United States – Nuffield Trust – 19 January 2011

Posted on January 24, 2011. Filed under: General Practice, Health Economics, Health Mgmt Policy Planning | Tags: |

GP commissioning: insights from medical groups in the United States – Nuffield Trust – 19 January 2011

Author: Ruth Thorlby, Dr Rebecca Rosen & Dr Judith Smith

Publisher: Nuffield Trust

“Handing control of commissioning budgets over to groups of GPs forms one of the most radical proposals set out by the Government in the NHS White Paper, Equity and Excellence: Liberating the NHS (Department of Health, 2010a).

For the past two decades some doctors’ groups in the United States have held the equivalent of a commissioning budget. Up to 2,000 doctor-led networks and groups emerged across the country from the mid-1980s onwards to contract with insurance providers and take responsibility for fixed budgets with which to deliver their patients’ care. Only a small proportion of these groups have survived to the current day.

As part of our work on international comparisons, senior researchers from the Nuffield Trust visited a number of medical groups led by doctors in California. This briefing paper is based on the findings from their study visit and highlights important lessons for the NHS in England as the Government prepares to transfer control of £80 billion of the NHS budget to GP consortia.

The US experience shows that holding risk-bearing budgets can motivate doctors to deliver efficient, coordinated care that reduces avoidable and repeated admissions to hospital. However, to achieve this, the groups had to ensure that primary and specialist doctors cooperated closely and were able to invest in a range of high quality and innovative services that offer alternatives to hospital care, particularly for older patients with chronic conditions.

The US experience also shows that those groups which initially underestimated the importance of investing in management support – including data and IT systems, experienced analysts, and other management and financial expertise – struggled at first to manage their responsibilities effectively.

GP commissioning: insights from medical groups in the United States will be of interest to policy-makers and commissioners of GP services, as well as academics and researchers in this area.”

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Social care and hospital use at the end of life – Nuffield Trust – 8 December 2010

Posted on January 14, 2011. Filed under: Palliative Care | Tags: |

Social care and hospital use at the end of life – Nuffield Trust – 8 December 2010
Author: Martin Bardsley, Theo Georghiou, Jennifer Dixon

“Care of the dying can be seen as an indicator of the quality of care provided for all sick and vulnerable people. About half a million people in the UK die each year, and the quality of care they receive also affects a much larger number of relatives, carers and friends. Although the costs of this care are also high, there is a shortage of information about the care people receive at the end of life and major gaps in our understanding of what services are appropriate.

This briefing summarises a Nuffield Trust report to investigate the use and estimated costs of hospital and social care services for large groups of individuals at the end of their lives, in three PCT/local authority areas. We believe that this is the first time that such an estimate has been derived for large populations. This type of analysis is the first step to achieving better quality of care for the available resources.

The techniques used in this analysis mark a significant step forward in terms of providing a better understanding of health and social care services used by people at the end of life. However, the analysis is partial. The Nuffield Trust has therefore been commissioned by the National End of Life Care Intelligence Network to conduct a more detailed follow-up study. This will involve a wider range of local authorities, and an extended number of datasets. It will report in 2011.

This briefing forms part of the Trust’s work on the commissioning of health care. It will be of interest to policy-makers, commissioners and managers within health and social care, as well as academics with an interest in this area.”

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Reforming health care: why we need to learn from international experience – Nuffield Trust – September 2010

Posted on September 22, 2010. Filed under: Health Systems Improvement | Tags: |

Reforming health care: why we need to learn from international experience – Nuffield Trust – September 2010

Jennifer Dixon and Vidhya Alakeson

“This paper provides an overview of system reform, using international examples, and highlights both how the health systems of countries at varying levels of economic development can benefit from adopting international good practice and the value of a truly global exchange on health system reform. It serves as a discussion document for an international summit analysing promising health reforms, hosted in partnership with Salzburg Global Seminar and the British Medical Journal, to be held in Salzburg, Austria on 7 to 12 November 2010.”

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Removing the policy barriers to integrated care in England – Nuffield Trust – September 2010

Posted on September 7, 2010. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

Removing the policy barriers to integrated care in England – Nuffield Trust – September 2010

Downloadable file: PDF, size: 878 KB

Chris Ham and Judith Smith

“International experience demonstrates that integrating healthcare services can deliver more efficient, patient-focused care. The White Paper, Equity and Excellence: Liberating the NHS, provides an opportunity to develop integrated care systems.

In the UK, a number of health and social care organisations are at the forefront of this initiative, but there are several policy barriers to be overcome if these systems are to be adopted more widely. This briefing uses five cases studies of health economies in the English NHS and examines how local clinicians and managers are working together to develop more coordinated services.

The authors conclude that the reforms outlined in the NHS White Paper, such as handing groups of GPs commissioning responsibilities, accompanied by real budgets, have the potential to deliver more seamless care for patients. However, the experiences of the areas studied – Torbay, Nottingham, Redbridge, Trafford and Cumbria – indicate that policy in areas such as GP commissioning and local leadership, competition, incentives and regulation needs to be developed to better support moves towards integration. They also stress the need to involve both clinicians and members of the public in service redesign.

Removing the policy barriers to integrated care in England will be of interest to health and social care policy-makers and senior managers, clinicians, senior social care practitioners and others with an interest in NHS and social care reform.

This briefing is the culmination of five seminars based on the assertion that policy-makers have given more attention to the development of competition in the NHS than the promotion of collaboration and integration, and examines what needs to be done to make more rapid progress towards better co-ordinated services in the NHS in England.”

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The Coalition Government’s NHS reforms: an assessment of the White Paper – Nuffield Trust – 10 August 2010

Posted on August 12, 2010. Filed under: Health Mgmt Policy Planning | Tags: , |

The Coalition Government’s NHS reforms: an assessment of the White Paper – Nuffield Trust – 10 August 2010

Author and publisher: Nuffield Trust 

Download full publication pdfDownloadable file: PDF, size: 230 KB

“The NHS is facing a major financial challenge. Official NHS sources suggest that, to meet rising demand, there will be a funding shortfall between 2011 and 2014 of £15 to £20bn. The Coalition Government has revealed its plans for reforming the NHS in England in the White Paper Equity and Excellence: Liberating the NHS. This briefing outlines the main features of the proposed reforms and assesses whether they are fit for purpose.”

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Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency? – 5 July 2010 – Nuffield Trust

Posted on July 8, 2010. Filed under: Emergency Medicine | Tags: |

Trends in emergency admissions in England 2004-2009: is greater efficiency breeding inefficiency? – 5 July 2010 – Nuffield Trust

“Approximately 35% of all admissions in the NHS in England are classified as emergency admissions, costing approximately £11 billion a year. Admitting a patient to hospital as an emergency case is costly and frequently preventable, yet the number of emergency admissions to hospitals has been rising for some time. This briefing paper examines the rise in emergency hospital admissions in England from 2004/05 to 2008/09 and tries to identify the possible explanations.”

Download full publication pdf

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Where next for integrated care organisations in the English NHS? – Nuffield Trust – 30 March 2010

Posted on April 7, 2010. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , , , , |

Where next for integrated care organisations in the English NHS? – Nuffield Trust – 30 March 2010
Author: Richard Q Lewis, Rebecca Rosen, Nick Goodwin & Jennifer Dixon

“Since the 1950s, the NHS has been looking at ways of improving care coordination. Lord Darzi’s NHS Next Stage Review introduced a new concept, that of the integrated care organisation (ICO). Since then, the Government has begun piloting schemes that offer different models of integrated care. This report, published jointly by The Nuffield Trust and The King’s Fund, examines some of these new models. It focuses in particular on organisations that combine commissioner and provider roles. These, the authors suggest, offer the most promise for aligning incentives to produce efficient care across primary, community and acute services.

Where next for integrated care organisations in the English NHS? forms part of work by both The Nuffield Trust and The King’s Fund examining new forms of structuring and delivering care over the coming decade.

This report will be of interest to healthcare policy-makers, senior managers and clinicians, and others involved in commissioning,as well as academics and students in the fields of healthcare and social policy.”

ISBN: 13-978-1-905030-42-2

Download full publication pdfDownloadable file: PDF, size: 629 KB

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Comparing NHS performance in the UK – Nuffield Trust – 2010

Posted on January 21, 2010. Filed under: Health Systems Improvement | Tags: |

Comparing NHS performance in the UK

A unique analysis published today of the performance of the NHS across the four countries of the UK before and after devolution has found striking differences in performance with some countries spending more on health care and employing greater numbers of health staff but performing worse when it comes to a range of indicators, such as waiting times and crude productivity of staff.

The report by the independent health charity the Nuffield Trust examines the performance of the health services in England, Scotland, Wales and Northern Ireland across three time points – 1996/7, 2002/3 and 2006/7. It also examines the performance of the ten English regions and compares them with the NHS in England as a whole and the NHS in each of the devolved countries in 2006/7. This is the first time such an analysis has been conducted. Performance was tracked against a number of key indicators, including expenditure, staffing levels, activity (outpatient appointments, inpatient admissions and day cases), crude productivity of staff and waiting times.”   … continues on the website 

View report

View summary briefing

View press release

Key slides

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NHS Mutual: engaging staff and aligning incentives to achieve higher levels of performance – 1 July 2009

Posted on July 2, 2009. Filed under: Health Policy, Health Systems Improvement, Workforce | Tags: , , |

NHS Mutual: engaging staff and aligning incentives to achieve higher levels of performance
Author: Chris Ham & Jo Ellins
Publisher: Nuffield Trust    1 July 2009     ISBN-13: 978-1-905030-39-2
Full text of the report

“Increasing staff involvement and motivation is critical to NHS reform. Since 1998, the NHS has launched many policy initiatives aimed at improving staff engagement. Despite some success, there is evidence that exhortation and guidance alone will not bring widespread changes to practice, and that ways for staff to participate formally in the running of their organisations should be explored.

NHS Mutual: Engaging staff and aligning incentives to achieve higher levels of performance looks at the factors that drive staff engagement in the health service, and examines various models of employee ownership in use both within and outside the NHS. The authors conclude that there are at least five ways in which employee ownership can be fostered within the health service, and that the time is now right for the Government to support those willing to test different approaches.

NHS Mutual is important reading for health care leaders and policy-makers. It will also be of interest to researchers and academic institutions with an interest in this area, as well as all those concerned with improving staff motivation and reviewing the options for social ownership in the public sector.”

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Across the Pond: Lessons from the US on Integrated Care – Nuffield Trust report January 2009

Posted on April 8, 2009. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

A report from the Nuffield Trust, called Across the Pond: Lessons from the US on Integrated Care is based on case studies of four integrated care systems in the United States in Colorado and the north west (Kaiser Permanente), Pennsylvania (Geisinger), and Minnesota (Health Partners). All the systems are not for profit but have different models and approaches to governance.

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