With a few exceptions, medical students have little, if any, training in management, leadership, and service improvement. Yet from the moment they graduate, doctors require a range of such competencies, which become more important as they progress to become consultants and general practitioners.

Early exposure to management and leadership should provide the foundation for an NHS in which doctors appreciate their responsibilities to others within the multi-professional team, the organisation, and local health community, as well as to their patients and themselves. more…

Substandard care within maternity services remains a high profile issue. It seems that every month there is news coverage about failing hospitals, avoidable maternal deaths, and below optimum care provided to mothers.

Last month the Care Quality Commission (CQC) issued a formal warning to a hospital outside Greater London following three visits in February 2012. They found an increased risk of patient safety being compromised due to staffing levels and failure to complete risk assessment forms. It is not sufficient for maternity teams to just address existing unsafe care, they need to look at risks proactively, and ensure that a rigorous and robust risk management system is in place. more…

The Department of Health’s Information Strategy is due to be published next month. It’s been a long time in development—it’s nearly two years since the government consulted on its aim to achieve an “Information Revolution.” So what should the strategy say if it is to start the revolution?

Put simply, the strategy needs to address two issues: collecting the right information, and making use of that information. In our Commission on the Future of NHS Leadership and Management last year, we argued that the NHS was over-administered but under-managed. There is a parallel here with the state of information. At least in the acute sector, it can feel as if the system is awash with information, but lacks real intelligence. We record, code, collect, collect, and collect, but too often we fail to really use that information to drive improvement. more…

The Prime Minister’s summit on implementing the NHS reforms has provided a new focus for debate about what the reforms will mean in practice. The government’s critics maintain that competition will undermine the core values of the NHS to the detriment of patient care. Some of these critics go further to claim that competition will result in the privatisation of much healthcare provision and the end of the NHS as we know it.

History suggests the need to treat these claims with caution, if not scepticism. Ever since the Conservative government introduced the internal market reforms in the early 1990s, opponents of choice and competition have warned that the future of the NHS is under threat, and yet it is performing better today than ever before. And as Nick Timmins showed in a recent analysis for the Financial Times, the private sector’s share of the market for elective care for NHS patients has remained stable,  giving the lie to the argument that widespread privatisation of provision is inevitable. more…

The interaction between physical and mental health has been attracting increasing attention across the political spectrum. Last year, the government recognised the importance of the issue with its mental health strategy “No health without mental health.” And more recently, Andy Burnham chose integration of mental and physical health care as the subject of his first major speech since returning to the health portfolio. more…

The report of the national audit of dementia care in general hospitals 2011, published last week, has put a sharp and timely focus on the care of people with dementia in hospitals and the need for improvements in the physical environment of care. A ward at King’s College Hospital, refurbished as part of The King’s Fund’s Enhancing the Healing Environment (EHE) programme, was used as an example of good practice in the extensive media coverage of the report.

Under the EHE programme, funded by the Department of Health, The King’s Fund has been working with acute and mental health trusts across England to develop more dementia friendly hospital environments. The programme has repeatedly shown that local clinically led teams working in partnership with estates colleagues, service users, and carers, can be creative in developing innovative, high-quality, value-for-money schemes that significantly improve the quality of care and the patient experience. more…

Over the next decade and beyond, the ageing population and the increased prevalence of chronic disease requires a step change in the way services are delivered. There needs to be a strong re-orientation away from the current emphasis on acute care towards prevention, self care, more consistent standards of primary care, and care that is well co-ordinated and integrated.

This new model of “integrated care” needs to be less focused on treating people when they become ill, and more focused on prevention and supporting people to manage their own healthcare issues in the home. In the longer term, it will only be through this approach that the foundations for a more sustainable model of care delivery can be created in the long term. more…

Obesity, and its control, is high on the public health agenda. Recently the Lancet published a series of important papers on the science and social science of obesity and its prevention. According to conservative estimates the projected obesity trends in the UK to 2030 imply 5,450,000 new cases of diabetes, 330,000 cases of coronary heart disease and stroke, and 87,000 cancers leading to an overall loss of 2.2 million quality adjusted life years in the population, all this costing almost £2bn per annum extra in health service costs. more…

The Commonwealth Fund’s survey of the experience of adults with complex care needs, published last week, paints a remarkably positive picture of the NHS. The results show that, of the eleven countries surveyed, the number of patients reporting that they did not use services because of concerns about cost was lowest in the United Kingdom. And while the absence of user charges in the NHS (with the exception of some prescription charges) means that this finding is not surprising, other results are equally encouraging. more…

The NHS in England faces a huge challenge over the next decade. The tighter public spending settlement for the NHS means the NHS will have to increase productivity in the order of four per cent per annum. The health sector is a labour intensive industry; it will only be possible to deliver productivity improvements by using human as well as financial resources differently.

Christensen et al have previously argued “Managers and technologies need to focus on enabling less expensive professionals to do progressively more sophisticated things in less expensive settings.”[1] At a recent Salzburg Global Seminar, supported by the Dartmouth centre for healthcare delivery science, the message was clear: healthcare teams need to transfer responsibility for delivering care to those that have the skills they need and no more. According to Al Mulley, director of the Dartmouth centre, healthcare delivery systems where staff “function at a lower level is inefficient, at a higher level unsafe.” more…