Are we expecting too much from the NHS?

Nuffield Trust, June 2018

Paper that explores the public’s expectations of the NHS, the balance between meeting those expectations and living within a constrained budget, and the question of who is responsible for keeping us healthy. It finds:

  • The public strongly identifies with the values and founding principles of the NHS. Recent polling suggests people are becoming increasingly concerned about the NHS, particularly in relation to lengthening waiting times and the level of funding provided by the government.
  • Resources for health care are finite; all health systems are required to make choices about how to allocate funds. However, a prolonged funding squeeze combined with rising demand has resulted in the NHS having to take increasingly difficult decisions at both local and national level, with the NHS currently struggling to meet core standards within its budget. The announcement in June of additional funding for the NHS is welcome but it does not provide the long-term cure that would restore it to full health. Further hard choices lie ahead and polling suggests the public is reluctant to accept measures perceived as ‘rationing’.
  • Underpinning the NHS is the idea of a contract between the individual and health services. In England, the NHS Constitution sets out the public’s rights and the NHS’s commitments, together with individual responsibilities. Most people accept they have a responsibility to contribute to their own health and wellbeing.
  • The most important influence on people’s health is the economic, physical and social environment in which they live. Consequently, while the NHS and individuals can play their part, it is essential that together, national and local government use the levers they have at their disposal (such as tax and regulation) to foster healthy environments. New polling suggests that the public are more receptive to such interventions than politicians often suppose.

Click here to view the full report.

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Posted in NHS

How good is the NHS?

The Nuffield Trust, June 2018

Nuffield Trust Report comparing the NHS to health systems in 18 similar developed countries, including France, Germany, Italy, Japan and the USA. It looks at three aspects of what we might mean by a good health care system:

  • the speed and accessibility of care,
  • the efficiency of the system, and
  • the outcomes delivered for patients.

It also sets the scene by looking at what the health service has to work with, so that we can consider whether it is doing a good job given the circumstances.  The report finds that the NHS performs neither as well as its supporters sometimes claim nor as badly as its critics often allege. Compared with health systems in similar countries, it has some significant strengths but also some notable weaknesses.

Click here to view the full report.

Posted in NHS

Developing new care models through NHS vanguards

National Audit Office, July 2018

This report examines whether the NHS is well placed to get value for money from its investment in developing new care models through vanguards. In particular, it focuses on:

  • set up and management of the vanguard programme (Part One);
  • national support and evaluation (Part Two);
  • progress made by the vanguards (Part Three); and
  • readiness for the spread of these new care models (Part Four).

This report focuses primarily on the two types of vanguards which were designed to test integrated models of health and social care for a local population: integrated primary and acute care systems (PACs) and multispecialty community providers (MCPs). The report also covers the six enhanced health in care homes (EHCHs) vanguards and the 13 acute care collaborations (ACCs) vanguards. We excluded from our report the eight urgent and emergency care (UECs)vanguards, which were all moved to another part of NHS England after the first year.

Finds individual vanguards have made progress in implementing new models of care and there are early signs of a positive impact on emergency admissions. But the evaluation is not yet complete and, while NHS England expects to achieve savings, the long-term impact and sustainability of vanguards is still not proven.

Click here to view the report.

The public and the NHS: What’s the deal?

The Kings Fund, June 2018

Report on three ‘deliberative workshops’ to explore how the public views its relationship with the NHS.

  • Finds that the relationship between the public and the NHS is strong, people are committed to its founding principles. There are several areas where the NHS could improve – not least around waste.
  • While there was a feeling that some people take the NHS for granted and demand too much, the workshops felt that their expectations of the NHS were largely being met and that those expectations were realistic.
  • Funding was seen as a problem and government is seen as responsible. Most people would be willing to pay more tax to maintain the NHS, and many people favoured a dedicated NHS tax.
  • There was recognition that some inappropriate use is made of the service placing additional pressure on the system. More could be done by the NHS to support responsible use of the service.
  • Individuals have a key role in keeping themselves healthy but mixed views about the role of the NHS – and wider government – in addressing this were evident.
  • There was mistrust of a ‘nanny state’, people often supported specific government interventions such as the smoking ban.
  • Demonstrates broad agreement for the concept of a contract or deal in clarifying the balance between an individual’s responsibility for their health and the government’s and the NHS’s responsibility.

Click here to view the full report.

Ideas for the NHS long-term plan from the Centre for Ageing Better

Centre for Ageing Better, June 2018

This paper sets out the case for why NHS England should make some bold commitments to healthy ageing in its long-term plan and suggests some ideas for actions it could take and some areas for action with others. It looks at:

  • Prevention
  • Supporting people managing long-term conditions and living with disabilities
  • Work and health
  • Housing and health

Click here to view the full report.

Taking The Value-Based Agenda Forward: The Five Essential Components Of Value-Based Approaches To Health And Care

NHS Confederation, June 2018

NHS Confederation report that explores how the adoption of value-based healthcare could be spread across all parts of the healthcare system, maximising the benefits for those who use NHS and wider services. It also explores the central challenge of how value-based healthcare is taken to the next stage and embedded across the whole system. Five key characteristics are identified:

  • Learning and adapting through innovation
  • Managing risk
  • Making best use of data
  • Thinking about pathways across the whole system
  • Listening to patients

Click here to view the full report.

The Sepsis Manual: 4th edition 2017 -2018

The Sepsis Trust, June 2018

Looks at the epidemiology of sepsis finding that while the recording of the number of cases of sepsis has improved and there is a better understanding of its impact on the NHS and society, we still have to estimate figures based on the best available data. Conservative estimates would suggest that we see at least 250,000 cases of sepsis in the UK each year, with at least 46,000 deaths and a direct cost to the NHS of at least £1.5 billion. The authors state that sepsis costs our society as much as £15.6 billion every year. It is highly likely that these numbers are significant under-estimates, since a proportion of the more than 1.5 million patients suffering severe infection in England every year are likely to have uncoded sepsis.

Click here to view the report.