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King’s fund

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…

Candace Imison: The future provider landscape—are foundation trusts taking us down a dead end?

15 Apr, 14 | by BMJ

candace_imisonA year ago NHS commissioning was ripped up by its roots, divided up and then pushed back into the soil. Like the plants in my garden that get such rough treatment, commissioners are struggling to flourish. The NHS provider architecture has, so far, had more gentle treatment, and the journey towards “liberalisation,” that started in 2004 with the establishment of the first foundation trusts, continues. more…

Sarah Gregory: What can we learn from how other countries fund health and social care?

31 Mar, 14 | by BMJ

England is not alone in facing the implications of an ageing population with changing patterns of illness. To inform the work of the independent commission on the future of health and social care in England, I have spent the past few months looking at how other countries are responding to these challenges.

By comparison with other OECD countries, two features of the English system stand out. First, we have an unusually defined split between our health and social care systems. By comparison, many countries have developed a funding system for social care that complements their funding for health. For example, Germany, France, Korea, and Japan have all introduced insurance for social care to complement their systems of health insurance. Second, we are at the lower end of the range for public spending on social care, although it is difficult to establish direct comparisons as we do not report on social care funding to the OECD. The UK spent 1.2 per cent of GDP on long term care in 2012/13, while the highest figure reported to the OECD was 3.7 per cent (in the Netherlands). more…

Vijaya Nath: Medical revalidation: trauma, trivia, triumph

17 Mar, 14 | by BMJ

The United Kingdom is the first country in the world to introduce the mandatory revalidation of its medical workforce. How does this process feel for those engaged in it?

The King’s Fund have been exploring this question with doctors on development programmes, in masterclass events, and in a recent qualitative study and have found some variation in the answer. more…

Richard Humphries: A year is a long time in the politics of integrated care

10 Mar, 14 | by BMJ

richard-humphriesWhen Andy Burnham set out his vision for “whole person care” at The King’s Fund last year, few would have disagreed with his crisp summation of the need to move towards one service that meets people’s needs as opposed to the three very different existing services—the NHS, mental health services, and social care.

The Labour Party went on to establish an independent commission led by Sir John Oldham to consider how this vision of whole person care could be achieved. Following this, the government set out its own stall with a new national collaboration framework for integrated care, featuring a programme of 14 co-ordinated care pioneers, and a £3.8 billion Better Care Fund—a pooled budget to be spent locally to provide better support at home and earlier treatment in the community. more…

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