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King’s fund

John Appleby: New NHS inflation figures underline funding pressures facing the NHS

20 May, 16 | by BMJ

john-applebyThe latest Quarterly Monitoring Report from the King’s Fund surveying NHS trust finance directors reveals deepening pessimism about local finances and concern about the outturn for the current financial year. New NHS inflation figures from NHS Improvement reveal the true extent of the financial pressures facing the NHS this year and up to 2020/21.

How much money the NHS has been allocated over the next few years is a somewhat contested fact. It shouldn’t be of course; how much the government has decided to spend on healthcare should be —in one sense at least—an uncontroversial figure. more…

How do the healthcare systems in the UK compare with others internationally?

3 May, 16 | by BMJ

sarah-gregoryTwo years ago I wrote about how health systems in other countries were grappling with the problems of how to support an ageing population with high rates of comorbidities. I was interested in the fact that the same policy problem can generate different solutions depending on the context in which it sits—so while it may appear that there is a sort of “free will” in decisions about policy, in reality decisions will always depend on the limitations of funding and political structures. more…

Chris Ham: Statesmanship among medical leaders could help resolve the junior doctors’ dispute

18 Apr, 16 | by BMJ

Whatever the rights and wrongs of the standoff between the government and junior doctors, failure to reach agreement on a new contract is bad for patients and for staff. The all out strike planned for the end of the month will cause disruption and delay for patients, and add to the pressures on staff who cover for absent colleagues. It will also create dilemmas for junior doctors torn between loyalty to their peers and their primary—and strongly felt—duty to patients.

The dispute may also affect recruitment into medicine and the willingness of newly qualified doctors to practise in England. It will have an impact too on the discretionary effort of junior doctors who form the backbone of patient care throughout the NHS. more…

What are the consequences of recent caps on NHS agency staff spending?

4 Apr, 16 | by BMJ

phoebe-dunn-portraitFour months since the first caps on agency spending were introduced by NHS Improvement—and after new framework agreements came into force last week—what do we know about the impact of these measures so far?

Unfortunately, not a huge amount. Although NHS providers are submitting weekly data returns to NHS Improvement, no official figures have yet been published. Without this we are, to some extent, in the dark about the effects of the measures, instead relying on piecing together other sources of information—such as Freedom of Information requests and individual trust and agency experiences—to try and gauge early indications of impact. more…

Chris Ham: The proposed NHS and social care commission should report quickly and engage with staff and the public

8 Feb, 16 | by BMJ

After the government’s spending review, the NHS has just over two years at best to stabilise rapidly deteriorating finances and declining standards of patient care. At that point the harsh reality of planned real growth in funding of only 0.2 per cent in 2018/19 (and even less the following year) will have to be confronted.

It is inconceivable that the NHS will be able to balance its books and maintain current standards, let alone implement new commitments such as seven day working, with such a small increase in its budget. And even if councils take advantage of new powers to increase council tax, social care faces a funding shortfall of approaching £3 billion by the end of the parliament. Something will have to give. more…

Chris Ham: Learning from others—devolved governance in the Australian state of Victoria

30 Nov, 15 | by BMJ

I spent a week working in Australia earlier this month and it made me reflect on similarities and differences with the NHS in England.

The funding context feels quite different, with healthcare spending in Australia having risen by 5% per year in real terms over the past decade. On the day I departed, a report in The Australian warned that this level of spending increase was unsustainable at a time of reduced economic growth and falling government revenues (the Chinese downturn being a key factor here). more…

Edward Wernick and Steve Manley: Meaningful patient collaboration—a mountain to climb?

15 Oct, 15 | by BMJ


In early September we arrived at the King’s Fund HQ in Cavendish Square to be welcomed to their new Collaborative Pairs Programme, designed to bring together 12 pairs from across the country—each made up of a healthcare professional and a patient or patient representative—to work on a shared challenge facing their local health system. The NHS Five Year Forward View and the current national programme for system change have focussed on developing a new relationship between citizens, communities and the health and social care system. From our respective positions, with clinical, strategic and community development experience between us, we know the challenges in turning this aspiration into a reality.

steve_manleyEach pair were asked to bring with them a “real” challenge that is a genuine current issue in their area. We will have five days over the next six months to utilise the support offered by the Kings Fund and the shared knowledge of other participating pairs. Our facilitators introduced the concept of the programme clearly…”To develop the skills and practices which enable collaborative relationships and offer a constructive, reflective space to learn about how to do this work well.” more…

Hugh Alderwick: Is the NHS delivering enough things right?

17 Sep, 15 | by BMJ

hugh_alderwickRecently, I’ve written blogs about overuse and underuse in the NHS—the problems of doing too much of the wrong things and not enough of the right ones. The final chapter in this story is misuse: when health services are poorly delivered, resulting in preventable harm to patients.

In reality, the distinctions between these three concepts are blurred. Take underuse and misuse: while harm sometimes happens because things aren’t done right (for example, people are given the wrong drug or operated on in the wrong place), it also happens because the right things to prevent harm aren’t done in the first place. more…

Ruth Robertson: Frontline teams are the key to delivering better value care for patients

22 Jul, 15 | by BMJ

ruth-robertsonWe need to talk about patients not pounds if we are to engage clinicians in meeting the NHS productivity challenge. That means focusing on providing the best possible health outcomes at the lowest possible cost, rather than a single-minded push to save money.

This is one of the main messages from our new report, Better value in the NHS: the role of changes in clinical practice, and was the main topic of discussion at The King’s Fund conference on better value healthcare. At that event, Sir Muir Grey put the issue more succinctly by asking the audience to join him in instigating a ban on the word “savings.” more…

Allison Trimble: A new relationship with patients and the community?

5 May, 15 | by BMJ

allison_trimbleThere are welcome signs that policy makers and NHS leaders are becoming more open to exploring how health professionals could work more collaboratively with patients as leaders—and support patients to be fully involved in their own care.

The NHS five year forward view rightly calls for a new relationship with patients, citizens, and communities, describing them as an “untapped resource” for the NHS. Many patient leaders are already working creatively with health professionals to improve health and wellbeing in their communities—offering a rich source of knowledge about local needs and skills in building relationships across diverse groups. The 29 vanguard sites will be developing the new care models outlined in the forward view. Each vanguard site and the fast followers—strong but unsuccessful applicants to be vanguard areas—will be expected to involve patient leaders, communities, and third sector partners in the formation and implementation of their plans. more…

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