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Nigel Edwards: Can we keep up with the demand for urgent and emergency care?

3 May, 13 | by BMJ

nigel_edwardsThe urgent and emergency care system is under severe pressure. Performance on a number of important indicators, including the four hour wait and ambulance handover targets, is heading in the wrong direction. Demand is growing and calls for work to be shifted out of hospital look oddly out of line with a system that cannot even constrain, let alone reduce, the rate of increase in many places. Our recent study for NHS South of England raises some questions about the management of urgent and emergency care and identifies some important lessons. more…

Chris Ham: Medical leadership must move from the margins to the mainstream

2 May, 13 | by BMJ

A new report from the health services management centre at the University of Birmingham and The King’s Fund, funded by the National Institute for Health Research, provides a comprehensive and up to date picture of the state of medical leadership in NHS trusts today.

Thirty years after the Griffiths report set out a vision of doctors taking control of budgets and services, our report finds that much remains to be done to realise this vision. In most of the trusts we studied, a small minority of doctors were involved in leadership, and most of those committed only one day a week to these roles. It is hard to escape the conclusion that medical leadership remains a minority interest on the margins of the NHS. more…

Partha Kar: The consultant of the future

21 Feb, 13 | by BMJ

Type “define an NHS consultant” into Google and you’ll get more than 5 million results—none of which actually crystallises what the role involves. It’s a term that’s ever more shrouded in ambiguity as the NHS morphs and changes while moving into the unknown future. more…

Vijaya Nath: Revalidation: opportunity or challenge?

28 Jan, 13 | by BMJ Group

On 3 December 2012, the UK was the first nation, and the General Medical Council (GMC) the first regulatory body, to implement large scale changes to the regulation of its medical workforce. By April 2016 it is expected that the “vast majority” of the UK’s 220,000 doctors would have undertaken revalidation—the process by which licensed doctors will demonstrate that they are up to date and fit to practise. Revalidation has been a popular topic in our leadership work with medical directors, GPs, and consultants, having presented both opportunities and challenges. So what have we learnt so far?   more…

Candace Imison: Will 2013 be the year of meaningful public engagement with service change?

21 Jan, 13 | by BMJ Group

candace_imisonThe Royal College of Surgeons (RCS) is the latest to join the growing chorus of medical colleges calling for change in hospital services with RCS President Professor Williams’s statement launching their new report: “2013 needs to be the year patients, politicians, clinicians, and managers come together to support historic change in the NHS and create a lasting legacy for all of our population.”

This follows statements from the Royal College of Physicians—”we must radically review the organisation of hospital care”—and the Academy of Medical Royal Colleges, which, in their call for a shift to seven day consultant care, also argued that services will need to be reconfigured onto fewer sites. All the colleges cite the need to adapt services to reflect advances in medicine and technology and the changing needs of patients, and therefore to drive up quality—arguments that have been made for decades. more…

Nick Goodwin: Jumping the gun in the telehealth steeplechase?

1 Aug, 12 | by BMJ

Nick GoodwinIf the adoption of telehealth were an Olympic sport, it would probably represent the steeplechase—an endurance event with obstacles that do not fall over when hit and with a 3.5 metre wide pit of water to jump across on almost every lap. Whilst many have been brave enough to try out for the event, most have decided not to enter at all as the barriers to success seem insurmountably steep.

By far the largest hurdle to the acceptance of telehealth has been the lack of robust evidence on outcomes to justify the investment. Earlier in the year, the Department of Health controversially published headline results from the Whole System Demonstrator trial ahead of the peer reviewed evidence. These results turned heads since they claimed telehealth led to significant reductions in hospital admissions and mortality. more…

Chris Ham: Integrated care North and South of the border

25 Jul, 12 | by BMJ

Proponents of integrated care in England sometimes look to Scotland as an example to be emulated. Yet, while the Scottish NHS has a much simpler structure that ought to facilitate integrated care, the reality is rather different. A report by the Auditor General for Scotland and the Accounts Commission published in 2011 found that community health partnerships, a key statutory vehicle for achieving integrated care, had not delivered on their promise, and recommended a fundamental review to ensure that partnership arrangements for health and social care were effective and efficient. more…

Anna Dixon: Evolution or revolution: the story behind the Health and Social Care Act 2012

17 Jul, 12 | by BMJ

Anna DixonIt was often difficult to know who to believe during debate about the Health and Social Care Bill. The public were faced with baffling technocratic details from government with no accompanying compelling narrative to explain the need for such significant reforms, alongside sensationalised claims from some who opposed it that the bill spelt the end of the NHS as we know it.

In his account of the story behind the bill, published yesterday by The King’s Fund and the Institute for Government (IfG), Nick Timmins sets the record straight. Through interviews with key players involved in the action, analysis of public speeches and documents, and his own personal observations as a journalist reporting on the bill, Nick has produced an illuminating account of the policy making process and suggested some lessons for government. The IfG have elaborated on some of the wider lessons for policy making. But how revolutionary were the reforms? Were they just a continuation of the market reforms begun in the early 1990s? And could any of these “mistakes” have been avoided if lessons had been heeded from previous major reforms to the NHS? more…

Angela Coulter: Please stop muddling shared decision-making and provider choice

1 Jun, 12 | by BMJ

Government departments are barred from making policy announcements during elections, so there’s always a flurry of them after the purdah period has ended. The aftermath of the recent local government elections was no exception. Hot on the heels of the publication of the long-awaited NHS Information Strategy came a document entitled No decision about me without me: further consultation on proposals to secure shared decision-making. As a long-time advocate of shared decision-making, I leapt on this as soon as it appeared on the Department of Health’s website, but was astonished to see that, despite its title, it wasn’t about shared decision-making at all, but about provider choice. more…

Vijaya Nath: The secret of Kaiser Permanente’s success

23 May, 12 | by BMJ Group

Much has been written about the integrated healthcare system that the Kaiser Permanente health group makes possible in the eight states and nine regions which it serves in America. But what did the participants who ventured to Kaiser in our recent study tour learn from the experience? And what is the value of taking NHS leaders out of their own system to learn from another?

On the tour, UK leaders joined equivalent representatives from 15 other countries and health systems. Participants wanted to hear first-hand about clinical engagement and physician leadership and this expectation was met at every level. The leaders of the system made clear the ingredients of the “secret sauce”—that is Kaiser Permanente’s key to success—without giving away the recipe. more…

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