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King’s fund

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…

David Buck: Tackling health inequalities: we need a national conversation

26 Feb, 14 | by BMJ

david_buckIn one of The King’s Fund’s most popular and commented on Time to Think Differently blogs last year, Gabriel Scally questioned whether we had lost the battle to tackle health inequalities. In December last year, NHS England released a document on their approach to reducing inequalities and now Public Health England has launched, rather quietly it has to be said, a national conversation on health inequalities. But why has this all taken so long? more…

Chris Ham: Making general practice fit for the future

21 Feb, 14 | by BMJ

General practice represents a paradox. On the one hand, it is widely and rightly viewed around the world as a model of primary care to be studied and emulated. On the other hand, it is based on small, independently minded units, unable to operate on the scale needed to meet changing population needs.

GPs in some areas recognise that practices have to change to rise to the challenges of an ageing population and shifting disease burden. We have studied four of these areas in our new report, Commissioning and funding general practice: making the case for family care networks, which describes how federations and networks of practices are working to deliver extended services and raise standards of care. These innovations in care are valuable, but much more is needed to ensure general practice really is fit for the future. more…

John Appleby: Care.data—your bits in their hands

13 Feb, 14 | by BMJ

Over the past few months there has been considerable debate and argument about plans by the NHS to collect and centrally collate details of individual patient records from general practice for the first time. Many have expressed worries about the care.data initiative and how potentially sensitive patient information will be used, who will have access to it (and for what reasons), and not least its security. Such fears are perhaps not just hypothetical given past examples of lost patient notes and what appear to be the misuse of sensitive patient information (even for the best of intentions). more…

Catherine Foot: Can the Care Quality Commission live up to expectations?

7 Feb, 14 | by BMJ

catherine_footThis week marks one year since Robert Francis published his second report into failures of care at Mid Staffordshire Foundation Trust.

Mid Staffs director of quality and patient experience, Julie Hendry, gave a moving presentation at a conference at the King’s Fund in November summarising the journey that the trust have been on since 2009, and the progress they have made and continue to make.

But what developments have there been more broadly across the system? more…

Vijaya Nath: Making revalidation work—what have we learnt so far?

16 Oct, 13 | by BMJ

Revalidation—the process by which licensed doctors demonstrate that they are up to date and fit to practise—was greeted with cynicism by some in the medical profession when it was introduced last year. But what have responsible officers—those who make recommendations to the General Medical Council (GMC) about doctors’ fitness to practise—thought about the process during its first six months? Our recent survey of responsible officers in London provided some interesting answers.

Responding to questions on what would improve the experience of revalidation in future, the responsible officers we interviewed broadly agreed on four areas. more…

Chris Naylor: Why we cannot afford to be pessimistic about CCGs

29 Jul, 13 | by BMJ

Clinical commissioning groups (CCGs) have a lot stacked against them. They have taken control of the majority of the NHS budget at a time when financial pressures are mounting and there is little hope of relief in the next few years. Some GPs have gone as far as to say they are being set up to fail.

The future of CCGs hinges to a large extent on the support they receive from local GPs. Clinical commissioning does not necessarily require substantial direct involvement from all or even most GPs. What it does need is widespread “buy in,” so that members feel a sense of collective ownership of their CCG and shared responsibility for its success. more…

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