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King’s fund

Hugh Alderwick: Is the NHS delivering enough things right?

17 Sep, 15 | by BMJ

hugh_alderwickRecently, I’ve written blogs about overuse and underuse in the NHS—the problems of doing too much of the wrong things and not enough of the right ones. The final chapter in this story is misuse: when health services are poorly delivered, resulting in preventable harm to patients.

In reality, the distinctions between these three concepts are blurred. Take underuse and misuse: while harm sometimes happens because things aren’t done right (for example, people are given the wrong drug or operated on in the wrong place), it also happens because the right things to prevent harm aren’t done in the first place. more…

Ruth Robertson: Frontline teams are the key to delivering better value care for patients

22 Jul, 15 | by BMJ

ruth-robertsonWe need to talk about patients not pounds if we are to engage clinicians in meeting the NHS productivity challenge. That means focusing on providing the best possible health outcomes at the lowest possible cost, rather than a single-minded push to save money.

This is one of the main messages from our new report, Better value in the NHS: the role of changes in clinical practice, and was the main topic of discussion at The King’s Fund conference on better value healthcare. At that event, Sir Muir Grey put the issue more succinctly by asking the audience to join him in instigating a ban on the word “savings.” more…

Allison Trimble: A new relationship with patients and the community?

5 May, 15 | by BMJ

allison_trimbleThere are welcome signs that policy makers and NHS leaders are becoming more open to exploring how health professionals could work more collaboratively with patients as leaders—and support patients to be fully involved in their own care.

The NHS five year forward view rightly calls for a new relationship with patients, citizens, and communities, describing them as an “untapped resource” for the NHS. Many patient leaders are already working creatively with health professionals to improve health and wellbeing in their communities—offering a rich source of knowledge about local needs and skills in building relationships across diverse groups. The 29 vanguard sites will be developing the new care models outlined in the forward view. Each vanguard site and the fast followers—strong but unsuccessful applicants to be vanguard areas—will be expected to involve patient leaders, communities, and third sector partners in the formation and implementation of their plans. more…

Matthew Honeyman: Reconfiguring NHS services: necessary but fraught with difficulties

20 Apr, 15 | by BMJ

matthew_honeymanWith the NHS facing growing pressures on all fronts, following the general election the next government is likely to begin a new round of NHS service reconfiguration planning. In addition, work will continue to implement the new care models—such as urgent and emergency care networks and modernised maternity services—set out in the NHS five year forward view. So what are the challenges around service reconfiguration? And what evidence is available to help guide this planning process? more…

Chris Naylor: Integrated care—the end of the hospital as we know it?

25 Mar, 15 | by BMJ

Hospitals are often seen as an impediment to integrated care. The concern frequently voiced is that their dominant role in the health system makes it harder for commissioners to shift resources into the community, and to develop more coordinated services that cross organisational boundaries.

It is certainly true that an over-reliance on hospital based care—and the political reluctance to challenge this—has long been a barrier to necessary change in health systems across the world. Jean Rebert, one of the principal architects of the PRISMA integrated care system in Quebec, Canada, has made this case forcefully. Speaking at the World Congress on Integrated Care in Sydney last year, he said that in his experience, the greatest obstacle to integrated care is the political attractiveness of prioritising investment in hospitals over other forms of care. more…

John Appleby: The cost of reform

13 Feb, 15 | by BMJ

john-applebyAsked in 1972 whether the French Revolution had been good or bad, the then Chinese Premier Zhou Enlai said that it was “too early to say.” As it turns out this was not an extreme example of the Chinese long view: Enlai was apparently opining about events that happened four years previously—in 1968—and not that other (somewhat more momentous) revolution that occurred more than 180 years earlier.

So, the coalition government’s reforms of the NHS: good or bad? As part of our review of the reforms of the NHS in England, the King’s Fund has argued that the changes introduced by the 2012 Health and Social Care Act led to a top-down reorganisation that has been damaging and distracting; structural change that is complex and confusing; and a new, fragmented system of leadership that is seen as a barrier to much needed change in services—such as integration across care and organisational boundaries. In short, the reforms were likely to turn out to be a costly diversion. more…

Chris Naylor: Is mental health finally becoming a political priority?

29 Jan, 15 | by BMJ

Last week saw announcements on mental health from both the government and the opposition. With the Liberal Democrats pledging to put mental health on the front page of their election manifesto, and Andy Burnham, Shadow Secretary of State for Health, making mental health a core part of his concept of “whole person care,” are we starting to see mental health becoming a higher profile political issue? more…

Bev Fitzsimons: Supporting community providers to improve quality

9 Dec, 14 | by BMJ

bev_fitzsimonsIf you look at how the NHS is represented in the media, healthcare dramas tend to equal hospital dramas: Casualty, Holby City, even the marvellous Getting on. Community services often feature as slightly misty eyed nostalgia of district nurses and midwives on bicycles—a bit of a blast from the past.

Hospitals can sometimes be busy, confusing places, to be avoided unless absolutely necessary—especially by people who are already vulnerable, frightened, or confused. Care provided closer to (or in) people’s own homes is often preferable in many circumstances. more…

Chris Ham: The NHS Five Year Forward View—the man matters more than the plan

6 Nov, 14 | by BMJ

Something very important happened on 23 October and it wasn’t the publication of the NHS Five Year Forward View.

Far more important was the passion and confidence with which Simon Stevens launched the plan and challenged politicians to provide the funding needed to deliver it. His performance stood in stark contrast to the bickering over the despatch box on the same day, when Labour and the Conservatives sought to claim the plan as their own. more…

Hugh Alderwick: The ups and downs on the road to health service improvement

19 Sep, 14 | by BMJ

hugh_alderwickParallels between the successful transformation of the Veterans Health Administration (VA) in the United States and the changes needed in the NHS in England have been made for a number of years. But recent troubles at the VA offer some important lessons for the NHS in the future, as explored in a roundtable discussion held at the King’s Fund last week.

The story of the transformation of the VA is familiar to many. Once a fragmented and hospital centred public healthcare system, changes made in the late 1990s helped the VA to become an organisation renowned for providing high quality, affordable care. more…

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