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NHS

Claire Severgnini: Why we need more fracture liaison services

4 Jul, 14 | by BMJ

ClaireAn estimated three million people in the UK have osteoporosis, and a recent survey of the National Osteoporosis Society’s members revealed that a fifth of women who have fractured bones sustain three or more breaks before being diagnosed.

That must change and osteoporosis must be diagnosed sooner. At the National Osteoporosis Society, we believe that everyone over 50 who suffers a break should be assessed for osteoporosis. This is why we are setting out our ambition to increase the number of fracture liaison services across the UK. more…

David Wrigley: Privatisation behind an invisibility cloak

26 Jun, 14 | by BMJ

david_wrigleyI was a guest speaker recently at a packed meeting in central Newcastle, where we discussed and debated the changes to the NHS. Everyone in the room was very concerned and indeed very angry at what they heard. A lot were unaware of the scale of the issue over privatisation in the English NHS.

Time and again I hear, “We didn’t vote for this at the last election—it wasn’t in any manifesto,” or “The coalition have no mandate to make such huge changes to our NHS—no single party won the election.” And I agree with them. The coalition has been very clever in making out that GPs were on board with the NHS changes (they weren’t), that it was what the NHS needed (it wasn’t), that the NHS is in a massive hole (it isn’t), and their coup de grace is that they are selling off many services to the private sector hidden behind the well trusted and well respected NHS logo. It is privatisation behind an invisibility cloak. more…

Hugh Alderwick: NHS performance—are we really getting it right?

24 Jun, 14 | by BMJ

hugh_alderwickAccording to the Commonwealth Fund, in the UK we’re getting it (mostly) right—or, at least, we’re getting it more right than our international counterparts. In their comparative study of health system performance in 11 countries, the UK ranks first across a range of measures covering quality, access, and efficiency of care, while the United States comes in last place.

While it’s nice to be told that the NHS is performing well, there are limits to how much we can learn from comparative rankings.

Firstly, different rankings by different people can tell us different things. The UK moves up and down in various international scorecards depending on which indicators have been included, and how different dimensions of performance have been weighted. Secondly, the Commonwealth Fund’s study is primarily designed to highlight poor performance in the US system. As we’re good at a lot of things the US isn’t—like access to care—we come out particularly well. more…

Simon Capewell: Spending NHS funds on weight management services—naughty or NICE?

20 Jun, 14 | by BMJ

Interior block 3I have been asked to write about the recent NICE (National Institute for Health and Clinical Excellence) recommendations on weight management services. I didn’t want to, I am already crazy busy as a public health academic. And I am usually a strong NICE supporter, previously describing it as a global exemplar. And I must confess an interest, having spent many days in hot stuffy rooms advising NICE on diverse issues.

However, few will read the full weight management report and appendices. So instead, read this first: NICE’s proposed list of new guidelines on the most effective interventions to prevent the major burdens of obesity, cardiovascular disease, and common cancers. NICE genuinely tried in 2010. But the UK government put a red pen through the 19 best proposals, effectively preventing NICE from looking at these more powerful, “upstream” policy interventions. more…

Billy Boland: The power of “systems” in healthcare

11 Jun, 14 | by BMJ

billy_bolandI looked down at my name badge. Although it said chief executive officer, I felt like an impostor. Across the table sat a suitably intimidating panel. The members of the Health Overview and Scrutiny Committee (HOSC) wanted me to justify why we were keeping open a crumbling hospital with poor outcomes, while the community was crying out for more resources. Expectant faces were staring at me, waiting for my presentation. A presentation? No one told me about that. I looked down at my notepad searching for something to say. It was blank.

This scenario was all part of a simulation, and one of the many training experiences I’ve undertaken at the NHS Leadership Academy.* The truth was, two days earlier, I’d never heard of the HOSC. Yet in this particular exercise, our trust board had come up with an options appraisal to tackle its ailing services and financial problems. Now it had to convince all and sundry, including this committee of councillors, that they were doing the right thing. The HOSC is an operation of the council in England and Wales, and has a role in independently reviewing and holding health services to account.

Such experiences are gravely familiar at the NHS Leadership Academy, which I am a part of. I have grown used to being dropped into difficult situations, and having to rely on my burgeoning skill set to figure out what to do. more…

Chris Hopson: You get what you pay for—a different approach to the 2015/16 NHS tariff is crucial

10 Jun, 14 | by BMJ

chris_hopsonIf you get what you pay for, then 2015/16 risks being a very difficult year for the NHS, as the system affordability challenge, according to Monitor, jumps from 3.1% to 6.6%. This is driven by increasing demand and costs, a flat NHS budget, changes to NHS pension arrangements, and the *Better Care Fund.

NHS providers are also contending with pressure on NHS England’s specialist commissioning budget, which was overspent by more than £800 million last year (of which over £400 million was covered by the use of non recurrent and contingency reserves), but which is a key source of income for many trusts. And, on top of this, NHS providers are also faced with unfunded demands for mandatory service improvements, such as seven day services and increased staffing ratios. more…

Ceinwen Giles: Patient leaders at the NHS Confederation Conference

10 Jun, 14 | by BMJ

ceinwen_gilesAs readers of The BMJ will know, leadership is a widely discussed and hotly debated topic across the NHS at the moment. It’s also a theme that permeated the NHS Confederation Conference in Liverpool last week. Of particular interest to me was the issue of patient leadership, as I was asked to speak at a plenary session called “Patients in the Driving Seat” on the last day of the conference.

As I walked around the conference, I heard much talk of the need to involve patients and work with them—some of it tokenistic, but much of it well meaning. Various sessions highlighted the value of working with patients in different ways, and provided examples of patients who had managed to bring about new services, or shape old services in a new way. more…

Azeem Majeed: Are federations the way forward for general practices in England?

9 Jun, 14 | by BMJ

Azeem_majeedAs general practices in England come under increasing workload, funding, and contractual pressures, a new type of primary care organisation—the GP Federation—is becoming more common. The RCGP defines GP federations as practices “working together to share resources, expertise, and services.” In their simplest form, federations allow the general practices in one locality to share some administrative functions, and work together to bid collectively for NHS contracts.

However, as GP federations are not statutory organisations, they vary widely in both their structure and the activities they undertake. Some of the more advanced federations have established themselves as independent legal entities, and have already begun to compete for contracts against NHS hospital and community trusts. more…

David Zigmond: Is it time to renationalise the NHS?

30 May, 14 | by BMJ

david_zigmond2Recently the media has told us that the Labour Party is considering a long journeyed return: back to the nationalisation of rail services. Some claim that this will offer better long term value, efficiency, and safety.

Many would welcome this, but there is a puzzling anomaly: why do we not, instead, start with the NHS? For surely, the contentious market principles of competitive commissioning are better suited to human transport than human healthcare. This is an important distinction, and our failure to recognise the difference between the mechanical and the human has led to a new tranche of serious NHS problems. more…

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…

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