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King’s fund

Bev Fitzsimons: Supporting community providers to improve quality

9 Dec, 14 | by BMJ

bev_fitzsimonsIf you look at how the NHS is represented in the media, healthcare dramas tend to equal hospital dramas: Casualty, Holby City, even the marvellous Getting on. Community services often feature as slightly misty eyed nostalgia of district nurses and midwives on bicycles—a bit of a blast from the past.

Hospitals can sometimes be busy, confusing places, to be avoided unless absolutely necessary—especially by people who are already vulnerable, frightened, or confused. Care provided closer to (or in) people’s own homes is often preferable in many circumstances. more…

Chris Ham: The NHS Five Year Forward View—the man matters more than the plan

6 Nov, 14 | by BMJ

Something very important happened on 23 October and it wasn’t the publication of the NHS Five Year Forward View.

Far more important was the passion and confidence with which Simon Stevens launched the plan and challenged politicians to provide the funding needed to deliver it. His performance stood in stark contrast to the bickering over the despatch box on the same day, when Labour and the Conservatives sought to claim the plan as their own. more…

Hugh Alderwick: The ups and downs on the road to health service improvement

19 Sep, 14 | by BMJ

hugh_alderwickParallels between the successful transformation of the Veterans Health Administration (VA) in the United States and the changes needed in the NHS in England have been made for a number of years. But recent troubles at the VA offer some important lessons for the NHS in the future, as explored in a roundtable discussion held at the King’s Fund last week.

The story of the transformation of the VA is familiar to many. Once a fragmented and hospital centred public healthcare system, changes made in the late 1990s helped the VA to become an organisation renowned for providing high quality, affordable care. more…

Rachael Addicott and Kieran Walshe: How do CQC hospital inspections measure up?

5 Aug, 14 | by BMJ

rachael-addicottOver the past few years, we have seen several high profile failures of care in NHS acute hospitals in England, leading many in the system to question the ability of performance management and regulatory mechanisms to identify and act on poor performance.

Last year, in response to these events and concerns, the Care Quality Commission (CQC) developed a new model for inspecting and regulating NHS acute hospitals, and commissioned a team from Manchester Business School and the King’s Fund to evaluate this new and evolving approach as they rolled it out. more…

Vijaya Nath: Medical engagement—change or die

21 Jul, 14 | by BMJ

vijaya_nathMore than a year since Robert Francis’s recommendations, and after reports by Don BerwickSir Bruce Keogh, and the new Care Quality Commission inspection regime, we are still being challenged to demonstrate that healthcare is first and foremost focused on the needs of the patient.

At the same time, there has been a call for the most expensive assets in healthcare—the doctors—to step up and engage in management and leadership. We use the right words when writing about medical engagement, but how do we move from rhetoric to reality and, more importantly, why should doctors embrace this responsibility? more…

Hugh Alderwick: NHS performance—are we really getting it right?

24 Jun, 14 | by BMJ

hugh_alderwickAccording to the Commonwealth Fund, in the UK we’re getting it (mostly) right—or, at least, we’re getting it more right than our international counterparts. In their comparative study of health system performance in 11 countries, the UK ranks first across a range of measures covering quality, access, and efficiency of care, while the United States comes in last place.

While it’s nice to be told that the NHS is performing well, there are limits to how much we can learn from comparative rankings.

Firstly, different rankings by different people can tell us different things. The UK moves up and down in various international scorecards depending on which indicators have been included, and how different dimensions of performance have been weighted. Secondly, the Commonwealth Fund’s study is primarily designed to highlight poor performance in the US system. As we’re good at a lot of things the US isn’t—like access to care—we come out particularly well. more…

Bev Fitzsimons: Practical tools to improve patients’ experience

6 Jun, 14 | by BMJ

bev_fitzsimonsAt the King’s Fund, we have spoken a lot about the benefits of collective leadership lately. With the challenges currently facing the NHS, leaders at all levels across organisations need to learn to work together with a shared vision of providing care. Leadership needs to be distributed throughout organisations, working alongside patients, rather than concentrated in a few individuals.

Our Patient and Family Centred Care (PFCC) programme, run in partnership with the Health Foundation, aligns extremely well with this vision. It involves working with a number of clinically led, multi-disciplinary teams to achieve patient centred care, showing how teams can make small changes that make a big difference to patients. We have seen what a huge difference it makes to staff to feel that they have the tools at their disposal to put themselves in their patients’ shoes, and to make changes that improve their experience of care. more…

Michael West: Collective leadership—fundamental to creating the cultures we need in the NHS

28 May, 14 | by BMJ

michael-westPositivity, compassion, respect, dignity, engagement, and high quality care are key to creating the cultures we need in the NHS. And, just as importantly, we must deal decisively, consistently, and quickly with behaviours that are inconsistent with these values—regardless of the seniority of people exhibiting them.

Yet in the King’s Fund’s most recent survey of NHS staff, two fifths of those surveyed felt that negative behaviours—typically incivility, aggression, discrimination, carelessness, brusqueness, and poor performance—were not being dealt with in a timely or effective fashion in their organisation. How then can we ensure that positive NHS cultures (with a focus on patient care) are encouraged, and inappropriate behaviours and performance are reduced? more…

Judith Hibbard: How do people become good managers of their own health?

19 May, 14 | by BMJ

OLYMPUS DIGITAL CAMERAWithin the general population some people actively focus on reaching and maintaining good health, while others are more passive about the whole thing. So what makes the difference?

Is learning to manage your health like learning a country’s geography—where all you probably need are a list of facts and a good reference guide? Or is it more like learning to swim—where facts and a reference guide would be of limited value? In this instance you need to acquire basic skills, like putting your face in the water and learning to float, but you must also practise to gain confidence before advancing to the next step. more…

Chris Ham: Wanted—an even Better Care Fund

7 May, 14 | by BMJ

The King’s Fund’s new analysis of serious and growing financial pressures in the NHS should serve as a wake up call to politicians of all parties. As the analysis shows, with an increasing number of providers in deficit, and the prospect of a further seven years of no growth in funding, the NHS is rapidly approaching a major crisis.

The arrival of this crisis has been accelerated by the transfer of almost £2 billion into the Better Care Fund in 2015/16. The purpose of the Fund—to support moves to integrate health and social care—is well intentioned. If it is used to support the kind of interventions we summarised in our recent evidence based guide, it should deliver benefits to the NHS as well as to social care. However, it will put additional stress on an NHS already struggling to balance the books and maintain acceptable standards of patient care. Acute hospitals will be particularly affected by the requirement to find even higher levels of efficiency savings than they have achieved to date. more…

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