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King’s fund

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…

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:—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 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…

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