By Anne Cooper, Clinical informatics advisor, NHS England
over 6 years ago
Our paper argues for a fundamental shift in how the NHS is reformed, learning from what has worked (and what has not) in England and elsewhere. This paper reviews the impact of three approaches to NHS reform in England since the late 1990s: targets and performance management, inspection and regulation, and competition and choice. It argues for a fundamental shift in how the NHS is reformed, learning from what has worked (and what has not) in England and elsewhere.
The King's Fund
almost 6 years ago
The Facts Unions have reacted with anger after a 1% pay rise was announced (half the rate of inflation), which excludes over 600,000 NHS staff including those who receive "progression-in-job" increases. NHS pay review body had recommended a 1% pay rise for all staff, but Jeremy Hunt said that it is "unaffordable and would risk the quality of patient care". View Ministerial Statement by the Department of Health Click here for further reading. What are your thoughts on this news?
over 6 years ago
Does the NHS really need saving? Your first question may be ‘does the NHS really need saving?’, and I would have to answer with an emphatic ‘Yes’. April this year sees the official start of Clinical Commissioning Groups (CCGs), the key component of The Health and Social Care Act, one of the biggest changes the NHS has seen. Amongst other things these organisations are tasked with saving the NHS £20 billion in the next 3 years by means of ‘efficiency changes’, despite the Institute of Fiscal Studies saying that the NHS needs to be spending £20 billion more each year by 2020. A daunting task but even more so in the light of the recently published Francis Report, where failings at Stafford Hospital have highlighted the need for compassionate patient care to be at the centre of all decisions. All of this has to be achieved in the largest publically funded health service in the world, which employs 1.7 million staff and serves more than 62 million people, with an annual budget of £106 billion (2011/12). So is it the solution? Clearly technology cannot be the only solution to this problem but I believe technology is pivotal in achieving the ‘efficiency changes’ desired. This might be direct use of technology to improve efficiency or may indirectly provide the intelligence that can drive non-technology based efficiencies; and if technology can be used to save clinicians time this can be reinvested into improving patient care. The NHS already has or is working on a number of national scale IT projects that could bring efficiency savings such as choose and book, electronic prescription service and map of medicine to name but a few. Newer and more localised projects include telehealth, clinical decision tools, remote working, the use of social media and real time patient data analysis. Yet many of these ideas, though new to the NHS, have been employed in business for many years. The NHS needs to catch up and then to further innovate. We need clinicians, managers and IT developers to work together if we are to be successful. Such change is not without its challenges and the size and complexity of the NHS makes implementation of change difficult. Patient safety and confidentiality has to be paramount but these create practical and technical barriers to development. I have just completed Connecting for Health’s Clinical Safety Training and there are some formidable hurdles to development and implementation of new IT systems in the NHS (ISB0129 and ISB0160). Procurement in the NHS is a beast of its own that I wouldn’t claim to understand but the processes are complex potentially making it difficult for small developers. The necessity of financial savings means the best solutions are not always chosen, even though that can be false economy in the long run. Yet we must not let these barriers stop us from seeking to employ technology for the good of clinicians and patients. We must not let them stifle innovation or be frustrated by what can be a slow process at times. The NHS recognises some of these issues and is working to try to help small businesses negotiate these obstacles. I hope in a series of posts in coming months to look in more detail at some of the technologies currently being used in the NHS, as well as emerging projects, and the opportunities and problems that surround them. I may stray occasionally into statistics or politics if you can cope with that! I am a practicing clinician with fingers in many pies so the frequency of my postings is likely to be inversely proportional to the workload I face! Comments are always welcome but I may not always reply in a timely manner.
Dr Damian Williams
over 7 years ago
Last Saturday on ITV’s The Jonathon Ross Show, TV personality and comedian Rufus Hound announced that his candidacy for the European Parliamentary elections in May, standing for the single issue National Health Action, NHA, party. This is something that I think we (those of us who value the spirit of the NHS) should all be grateful for. The government is changing the NHS, big business is coming and no one seems that angry. Well at least Rufus is... "David and Jeremy want your kids to die (unless you’re rich)" A provocative title for his accompanying blog post, which of course has helped to fuel discussion. However, I think Mr Hound was right to use this, let’s face it anything that aggravates Toby Young, I am going to look upon gladly. OK, it is dramatised, but based on the evidence we have, it does seem that Misters Cameron and Hunt want an end to the NHS as we know it (an NHS that does indeed do its utmost to prevent any child from dying). We have had top down organisation and privatisation, from parties that promised the opposite pre-election, with an opposition who seem to accept the changes, and had themselves help start the privatisation of the NHS. You can see why Rufus has turned to NHA party, why hasn't everybody else? What will Rufus achieve? To be honest I don’t think a lot. If he actually manages to be elected, as a MEP his campaigning will be in Brussels not Westminster. There is one key piece of legislation that the NHA will be looking to stop, the EU/US free trade agreement, which if passed including the NHS will mean that privatisation will not be reversible. The health and social care act opened up contracting opportunities in the NHS for multinationals and the free trade agreement will mean that future governments will be powerless to reverse the private contracting of these overseas companies. The three main parties are broadly supporting this agreement. Good Luck Rufus. Rufus has already achieved something though. He has brought the issue he feels so strongly about to the public’s attention, in a way that no backbencher, lobbyist or journalist ever could. Since his announcement NHA party has been discussed across national media. People realise the NHS is being changed and are starting to speak up. I hate to think of the NHS going the same way as Britain’s utilities. Shareholders and profit should be nothing to do with the health and well-being of the country. Apparently not all clowns are evil. Rufus Hound: Comedian, Radio 4 presenter, argumentalist, and now would be politician. Some further reading: Rufus's blog http://rufushound.wordpress.com/ Trade secrets: will an EU-US treaty enable US big business to gain a foothold? http://www.bmj.com/content/346/bmj.f3574 It’s time to get serious about NHS, says comedian Rufus Hound. http://www.independent.co.uk/news/uk/politics/its-time-to-get-serious-about-nhs-says-comedian-rufus-hound-9086435.html
Joe de Silva
over 6 years ago
The NHS provides care free at the point of us to British citizens and anyone who needs emergency care while in the UK. It tries to provide every kind of service and treatment that it can but obviously there are limits. The NHS gets its money mainly from governments taxes, charities, research grants, some payment for services and from renting out retail space etc. Healthcare is a financial blackhole, any money put in the budget will get spent, efficiently and effectively or not. The NHS is constantly being expected to provide a better, more efficient service and new treatments, without a comparable increase in government funding. So, why doesn’t the NHS set up services that could make it money? Some money making suggestions Gift shops and NHS clothing brand – The American hospital I went to for elective had quite a large shop near the entrance that sold hospital branded goods. People love the NHS and it could make itself a brand, “I love the NHS” t-shirts, “I was born here” ties, “I gave birth at Blah hospital” car stickers, hats, jackets, tracksuits, teddy bears in white coats and so many more things could be sold in this shops to raise money for the NHS. Patients in a hospital are a captive market and their visitors are semi-captive. The captives get very bored! Why not provide opportunities for these people to spend their money and relieve the boredom while they are in hospital with some retail therapy? For instance, new hospitals should be built with a shopping mall in them and a cinema. A couple of clothes shops would give people something to do and raise money from rent. While we are on the subject of new hospitals, they should be designed with the input of the clinical staff who know how to maximise the flow of patients through the "patient pathway". Hospitals should be built like industrial conveyor belts: patients enter through ED, get stabilised, get fixed in theatre, stabilised again in ITU, recover on the wards and out the exit to social services and the outpatient clinics. New hospitals should be designed to sit on top of HUGE underground multi-story car parks. If shopping centres can do this then so can hospitals. Almost all hospitals are short of parking spaces and most car parks are eye sores. So, try to plan from the beginning to get as many car parking spaces as possible. Estimate how many are needed for staff and visitors - then double it! Also, design a park and ride system so additional parking is available off site. If costa can make money from a coffee shop in an NHS hospital, why isn’t the NHS setting up its own brand of high quality coffee shops in the hospitals and cutting out Costa the middle man? “NHS healthy eating” – NHS branded diet plans or ready meals could be produced in partnership with a supermarket brand. Mixing public heath, profit and the NHS brand. “Good for you and good for the NHS” The NHS could set up hospitals abroad that are for profit institutions that use the NHS structures, or market our services to foreigners that they then pay for. Health tourism is a thing, why not make the most of it? “NHS plus” – the NHS should be a two tier system. Hours of 8am til 6pm should be for elective procedures free at the point of use and free emergency care. Between 6pm and 11pm the hospitals currently only do emergency care, so there is loads of rooms and kit lying about unused. Why not allow hospitals to set up systems where patients can pay for an evening slot in the MRI scanner and cut the queue? Allow surgeons to pay to use the facilities for private procedures in the evenings. Allow physicians to pay to use the outpatients clinics for private work after hours. An “NHS Journal” could publish research and audits conducted within and relevant to the NHS. “NHS pharma” – the NHS buys a huge amount of off patent drugs, why not produce them itself? Set up a drug company that produces off patent medication, these can be given to the NHS at cost price and sold to other healthcare providers for profit. NHS pharma could also work with British universities and researchers to produce new drugs for the British market that would be cheaper than new Drug company drugs because they wouldn’t need huge advertising budgets. There are so many ways the NHS could make more money for itself that could then be used to deliver newer and better treatments. Yes, it is a shift in ideology and culture, but I am sure it would have positive outcomes for the NHS and patients. If you have any ideas on how the NHS could produce more money then please do leave a comment.
almost 6 years ago
A Christian health worker claims the NHS made her look "a bit crazy" by disciplining her for allegedly trying to convert a Muslim colleague.
about 5 years ago
"This Rolls Royce isn't moving fast enough!"
about 5 years ago
An Idiot's Guide to the e-Portfolio video 1, An Introduction and Overview. By Nathaniel Roocroft and Jake Matthews.
almost 5 years ago
Children's palliative care in Wales needs more "strategic attention" by ministers and the NHS, a new report says.
almost 5 years ago
Here is a video of the an impromptu performance of Save Our Contracts at the Junior Doctors protest in London. Please help spread these videos over social me...
over 4 years ago