A think-tank report presented findings from a survey of people with long-term health conditions, which asked their views on self-managing their conditions and having more of a say over their services. The report called for: people to be given a named contact for day-to-day queries about their health, healthcare, and care co-ordination; patients to have legal ownership of medical records, and better information and advice; peer support, facilitated by organizations within the local health economy; comprehensive healthcare plans, drawn up in partnership with patients; and personal, integrated health and social care budgets, based on healthcare plans.
Source: Catherine McDonald, Patients in Control: Why people with long-term conditions must be empowered, Institute for Public Policy Research
Links: Report | Summary | Alzheimers Society press release
Date: 2014-Sep
A report called for person centred care to become the central ambition for health reform in England, to improve the quality of life, health, and well-being of people, and the sustainability of care systems. It also discussed the potential contribution of the voluntary and community sector. Recommendations included: for a greater focus on preventive public health measures; to make people the centre of reform, with 'what matters to people' forming one of the key organizing principles for services; for better support and shared decision making for people with chronic conditions and disabilities; for recognition of the role of carers, volunteers, engaged citizens, and the voluntary and community sector, with better support and investment; for better funding for health and social care; and for an end to top-down reorganizations of services.
Source: Person Centred Care 2020: Calls and contributions from health and social care charities, National Voices
Links: Report | National Voices press release
Date: 2014-Sep
An article examined patient mortality in hospitals running the Advancing Quality programme, a pay-for-performance programme introduced in all hospitals in the north west region of England in 2008. An earlier article had reported a reduction in mortality in the first 18 months of operation, and this article now examined the longer term trends. It said that, while the quality of care continued to increase over the following two years, there had been no further reduction in patient deaths in the region covered by the programme over that observed in the rest of England.
Source: Soren Rud Kristensen, Rachel Meacock, Alex Turner, Ruth Boaden, Ruth McDonald, Martin Roland, and Matthew Sutton, 'Long-term effect of hospital pay for performance on mortality in England', New England Journal of Medicine, Volume 371 Number 6
Links: Abstract
Date: 2014-Sep
A report provided findings from a commission that examined options for a new settlement for health and social care in England. Overall, it recommended: moving to a single, ring-fenced budget for the National Health Service and social care, with a single commissioner for local services; for a new care and support allowance; for greater focus on more equal support for equal need (with more social care free at the point of use); and for the use of personal budgets and additional support to promote independence. The report proposed funding changes (including changes to national insurance contributions) to meet the additional costs and said that various forms of wealth taxation should be reviewed, with a view to generating additional resources for health and social care funding.
Source: Commission on the Future of Health and Social Care in England, A New Settlement for Health and Social Care: Final report, King's Fund
Links: Report | Project | Kings Fund press release | Alzheimers Society press release | CSP press release | NCPC press release | RCN press release | RPS press release | Turning Point press release | UNISON press release | Guardian report | Telegraph report
Date: 2014-Sep
A report examined the cost impact of earlier diagnosis in cancer treatment services for four types of cancer (colon, rectal, non-small cell lung, and ovarian). It said that there were marked variations in early diagnosis across England and that significant savings could be realized if all clinical commissioning groups (CCGs) were able to achieve the level of early diagnosis of the best. The report made a range of recommendations, including that earlier diagnosis should be viewed as an efficiency as well as a quality priority for the National Health Service, and that all CCGs and local health and well-being boards should set out plans to encourage this.
Source: Incisive Health, Saving Lives, Averting Costs: An analysis of the financial implications of achieving earlier diagnosis of colorectal, lung and ovarian cancer, Cancer Research UK
Links: Report | CRUK press release
Date: 2014-Sep
A report said that the financial challenge facing the National Health Service posed risks to the quality of care it provided, because the estimated potential savings from productivity improvements were insufficient to meet shortfalls in funding (projected to reach £30 billion by 2021). The report outlined three forms of support that were now needed: support in implementing improvements to services and to deliver integrated care (skills such as basic management, change management, improvement skills, and analysis); targeted resources, in the form of a 'transformation fund' and additional ongoing operational funding; and political openness and support for change.
Source: Richard Taunt, Alecia Lockwood, and Natalie Berry, More than Money: Closing the NHS quality gap, Health Foundation
Links: Report | Health Foundation press release
Date: 2014-Sep
A report said that the financial challenge facing the National Health Service posed risks to the quality of care it provided, because the estimated potential savings from productivity improvements were insufficient to meet shortfalls in funding (projected to reach £30 billion by 2021). The report outlined three forms of support that were now needed: support in implementing improvements to services and to deliver integrated care (skills such as basic management, change management, improvement skills, and analysis); targeted resources, in the form of a 'transformation fund' and additional ongoing operational funding; and political openness and support for change.
Source: Richard Taunt, Alecia Lockwood, and Natalie Berry, More than Money: Closing the NHS quality gap, Health Foundation
Links: Report | Health Foundation press release
Date: 2014-Sep
An article examined patient mortality in hospitals running the Advancing Quality programme, a pay-for-performance programme introduced in all hospitals in the north west region of England in 2008. An earlier article had reported a reduction in mortality in the first 18 months of operation, and this article now examined the longer term trends. It said that, while the quality of care continued to increase over the following two years, there had been no further reduction in patient deaths in the region covered by the programme over that observed in the rest of England.
Source: Soren Rud Kristensen, Rachel Meacock, Alex Turner, Ruth Boaden, Ruth McDonald, Martin Roland, and Matthew Sutton, 'Long-term effect of hospital pay for performance on mortality in England', New England Journal of Medicine, Volume 371 Number 6
Links: Abstract
Date: 2014-Sep
An audit report said that the approach of the Department of Health and NHS England to allocating funding was generally sound, but the tighter financial position in recent years had made it difficult to allocate funding in a way that achieved both fairness and financial stability, with financial stability having been prioritized. The report said that the achievement of target allocations, based on relative need, was greatly varied, with over three-quarters of local authorities and nearly two-fifths of clinical commissioning groups having received more than five percentage points above or below their 'fair share' of funding per person for 2014-15.
Source: Funding Healthcare: Making allocations to local areas, National Audit Office
Links: Report | Summary | NAO press release | Guardian report
Date: 2014-Sep
An article examined the exercise of rationality in the work of Individual Funding Request panels in the National Health Service in England. It said there was a delicate balance between being 'human' and being 'rational' that created a dilemma for panels. It suggested placing greater value on narrative ethics as an aid to understanding resource allocation.
Source: Jill Russell and Trisha Greenhalgh, 'Being "rational" and being "human": how National Health Service rationing decisions are constructed as rational by resource allocation panels', Health, Volume 18 Issue 5
Links: Abstract
Date: 2014-Jul
A report examined National Health Service expenditure between 2010 and 2014. It said that, until the previous year, the National Health Service had been coping well with increasing demand and the consequences of public sector austerity, but that the system was now showing signs of severe financial pressure, with the ability to make savings diminishing alongside a continued increase in demand for services.
Source: Sarah Lafond, Sandeepa Arora, Anita Charlesworth, and Andy McKeon, Into the Red? The state of the NHS' finances, Nuffield Trust
Links: Report | Nuffield Trust press release
Date: 2014-Jul
A new book examined the links between governance and population health, examining how principles, such as social justice, and governance arrangements, including standards and targets, influenced local strategies and priorities for public health investment.
Source: Linda Marks, Governance, Commissioning and Public Health, Policy Press
Links: Summary
Date: 2014-Jul
An article examined how the 'problem' of health spending was defined in Canada, the United Kingdom and the United States, presenting the results of a content analysis of print media during the period 2005 2010.
Source: Michael Gusmano and Sara Allin, 'Framing the issue of ageing and health care spending in Canada, the United Kingdom and the United States', Health Economics, Policy and Law, Volume 9 Issue 3
Links: Abstract
Date: 2014-Jun
An article examined whether the policy of increasing National Health Service funding to a greater extent in deprived areas in England (compared with more affluent areas) led to a reduction in geographical inequalities in mortality amenable to healthcare. It concluded that, between 2001 and 2011, increased resources were associated with a reduction in absolute health inequalities, and that ending this policy may widen inequalities.
Source: Ben Barr, Clare Bambra, and Margaret Whitehead, 'The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study', BMJ, Volume 348
Links: Article
Date: 2014-Jun
A paper provided initial findings from research that examined mental health services commissioning processes from the perspective of the public sector bodies responsible for its implementation and the third sector organizations (TSOs) who engaged with commissioners. It said that, although practice had changed to some extent, there was also considerable continuity, particularly in the importance of relationships. Many TSOs were said to welcome regular tendering as an opportunity to expand their services, but large scale changes within commissioning organizations (such as in health or social services) appeared to lead to disruption in the commissioning process and in relationships. The report concluded that commissioning was yet to fulfil its expected potential in improving outcomes for people with mental health problems, and in efficiency improvements, but it was not possible to infer whether this was caused by its, as yet, incomplete implementation, or whether the underlying principles were fundamentally flawed. It warned that, without the necessary capacity, time, and expertise, commissioning was unlikely to succeed.
Source: James Rees, Robin Miller, and Heather Buckingham, Public Sector Commissioning of Local Mental Health Services from the Third Sector, Working paper 122, Third Sector Research Centre (University of Birmingham)
Date: 2014-Jun
An article examined the introduction of personal health budgets in England's National Health Service, which had been subject to a three year programme of pilots. The article argued that the government had attributed the success of the pilots to the wrong factors, and questioned whether success would be replicated when the budgets were rolled out more widely.
Source: Colin Slasberg, Nick Watson, Peter Beresford, and Peter Schofield, 'Personalization of health care in England: have the wrong lessons been drawn from the personal health budget pilots?', Journal of Health Services Research and Policy, Volume 19 Number 3
Links: Abstract
Date: 2014-Jun
A report said that the National Health Service in Wales could face a funding shortfall of £2.5 billion by 2025-26 if funding rose in line with inflation beyond 2015-16 (known as flat real terms spending), even after accounting for the efficiency savings currently being made. The report attributed the rising pressures on the service in Wales to a range of factors, including the ageing population, the impact of chronic disease on hospital admissions levels, and increased operating costs (primarily due to wage pressures). The report said that the funding gap could be reduced to £1.1 billion by increasing spending in line with economic growth levels, and that the shortfall could then be largely closed through sustained productivity gains and improved treatment for chronic conditions.
Source: Adam Roberts and Anita Charlesworth, A Decade of Austerity in Wales? The funding pressures facing the NHS in Wales to 2025/26, Nuffield Foundation
Links: Report | Nuffield Foundation press release | Guardian report
Date: 2014-Jun
A report examined the integration of health and social care, the Better Care Fund, and the role of county councils in shaping the future of care in England. The report drew on the findings of a survey of county councils.
Source: Delivering the Better Care Fund in Counties, County Councils Network
Links: Report | Public Finance report
Date: 2014-May
A report examined the use of, and outcomes from, integrated care funding transfers for 2012-13 and 2013-14, which were granted to support adult social care services that also had a health benefit, encourage health and social care integration, support existing services facing budget pressures, or deliver new services through transformation programmes. Based on freedom of information requests sent to local authorities in England, the report said that funding was used primarily as a means to support existing services, rather than to transform and more closely integrate health and social care services. It said that there was a wide variation in how funding was invested and reported, but it was not sufficient to meet increasing health and social care needs of local populations, there was a lack of robust outcomes data, and less than 4 per cent of funding had gone to local mental health services. The report concluded that, while there had been much support for the integration of health and social care, service change remained subject to significant local variation and the results had important implications for the introduction of the Better Care Fund from 2015.
Source: All in this Together? An analysis of spending on integrated care by commissioners in the new health and social care system, MHP Health
Links: Report | National Care Forum report
Date: 2014-May
The government responded to a report by a committee of MPs on public expenditure on health and social care.
Source: Government Response to the House of Commons Health Select Committee Report into Public Expenditure on Health and Social Care, Cm 8836, Department of Health, TSO
Links: Response | MPs report
Date: 2014-Apr
A report examined the impact on young people of budget cuts to Early Intervention in Psychosis (EIP) services, which were designed to help young people aged 14-35 to recover from a first episode of psychosis. It said that services in England were finding it difficult to survive, with 50 per cent having seen budgets reduce in the past year, 58 per cent having lost staff, and 53 per cent reporting a decline in the quality of their service. The report said that young people's chances of recovery from psychosis were being compromised by delayed access to EIP services. It called on the government to introduce a maximum waiting time of 28 days and for health commissioners to ensure that full EIP services were available.
Source: Lost Generation, Rethink Mental Illness/Iris Network
Links: Report | Mind press release | BBC report | Related Guardian report
Date: 2014-Mar
A report examined the role of integrated financial mechanisms in supporting and incentivizing integrated health and social care. The report was based on a literature review, which found 38 studies across eight countries (including England). It said that schemes that integrated funds and resources seldom led to improved health outcomes and, if schemes were successful in assessing patient needs, they would be likely to identify previously unmet need, thus increasing overall cost. The report said that the evidence from England revealed that outcome evaluation was challenging, as new schemes often emerged in the context of other evolving policy initiatives, and that future policy should bear this in mind.
Source: Anne Mason, Maria Goddard, and Helen Weatherly, Financial Mechanisms for Integrating Funds for Health and Social Care: An evidence review, Centre for Health Economics (University of York)
Links: Report | CHE press release
Date: 2014-Mar
A think-tank report said that there was a 'crisis' of cash and care in the National Health Service in England, with a system that was unnecessarily expensive and poorly designed to meet modern needs. It said that, if not resolved, the situation would deteriorate and it would be impossible to preserve the National Health Service without cutting other public services or raising taxes significantly. The report made recommendations for change, arguing that funding from general taxation should rise only with inflation, and proposing a National Health Service membership scheme for United Kingdom residents.
Source: Norman Warner and Jack O'Sullivan, Solving the NHS Care and Cash Crisis: Routes to health and care renewal, Reform
Links: Report | BBC report | Guardian report
Date: 2014-Mar
A paper examined options for reforming the payment system in the National Health Service in England, drawing on the findings of an evidence review that was published at the same time. Recommendations included: that changes should be targeted on where they might have the greatest impact; that they should be aligned with wider system changes; and that they should be transparent, evidence-based, predictable, and credible.
Source: Anita Charlesworth, Loraine Hawkins, and Louise Marshall, NHS Payment Reform: Lessons from the past and directions for the future, Nuffield Trust
Links: Paper | Evidence review
Date: 2014-Feb
A report by a committee of MPs said that the National Health Service had made savings, but there was a question mark about the sustainability of savings (particularly related to pay restraint) and it was not clear how the money saved had then been spent. The report noted the challenges surrounding the integration of the health and social care sectors, where one budget was static and the other reduced at a time of rising demand, and recommended that the existing level of real terms funding for social care should be ring-fenced. The committee noted the consequences of integration for commissioning and repeated its earlier recommendations for health and well-being boards to develop an overarching role across health and social care, and for a review to establish the best method of consolidating commissioning through the boards.
Source: Public Expenditure on Health and Social Care, Seventh Report (Session 2013–14), HC 793, House of Commons Health Select Committee, TSO
Links: Report | Foundation Trust Network press release | NHS Confederation press release | King's Fund press release | BBC report
Date: 2014-Feb
An article reported on the evaluation of personal health budgets in England. It said that the budgets were associated with a significant improvement in patients' care-related quality of life and psychological well-being at 12 months. They did not appear to have an impact on health status, mortality rates, health-related quality of life, or costs over the same period. Overall, they were cost-effective: that is, budget holders experienced greater benefits than people receiving conventional services. The evaluation provided support for the planned wider roll-out of personal health budgets in the English National Health Service after 2014.
Source: Karen Jones, Julien Forder, James Caiels, Elizabeth Welch, Caroline Glendinning, and Karen Windle, 'Personalization in the health care system: do personal health budgets have an impact on outcomes and cost?', Journal of Health Services Research and Policy, Volume 18 Number 2
Links: Abstract
Date: 2014-Feb
The regulator for National Health Service services in England published a report that summarized issues raised following a call for evidence in July 2013. The call had sought to understand how well the arrangements for commissioning and providing general practice (family doctor) services were working for patients. The report summarized responses under three headings: access and quality; the ability of new or existing providers to develop the scope of their offer to the National Health Service; and providers' ability and incentives to work together to benefit patients. It outlined work currently being undertaken in the sector to address those issues and identified areas where the regulator could provide support to improve services for patients.
Source: Discussion Document Following Monitor's Call for Evidence on GP Services, Monitor
Links: Report | Call for evidence
Date: 2014-Feb
An article examined the implications for the National Health Service of inward and outward flows of private patients (often referred to as 'medical tourism'). It said that there had been an increased flow of patients in both directions during the previous ten years, that Europe was both a source and recipient of patients, and that inward travel often involved either expatriates or people from nations with historic ties to the United Kingdom. It noted the lack of regulation, variable levels of trustworthy information, and associated risk to patients. It made a range of recommendations for further research.
Source: Neil Lunt, Richard Smith, Russell Mannion, Stephen Green, Mark Exworthy, Johanna Hanefeld, Daniel Horsfall, Laura Machin, and Hannah King, 'Implications for the NHS of inward and outward medical tourism: a policy and economic analysis using literature review and mixed-methods approaches', Health Services and Delivery Research, Volume 2 Issue 2
Date: 2014-Feb
A report examined the evidence on different approaches to payment for services in the National Health Service in England, and whether recent payment initiatives had met their goals. It was published alongside a policy response, which outlined possible short- and long-term payment reforms.
Source: Louise Marshall, Anita Charlesworth, and Jeremy Hurst, The NHS Payment System: Evolving policy and emerging evidence, Nuffield Trust
Links: Report | Policy response
Date: 2014-Feb
The Welsh Assembly approved the National Health Service Finance (Wales) Act. The Act was designed to remove the existing annual financial duty in the National Health Service (Wales) Act 2006, replacing this with a 3-year rolling financial duty, together with a tolerance threshold.
Source: National Health Service Finance (Wales) Act, Welsh Government, TSO
Links: Act | Explanatory notes | Welsh Government press release
Date: 2014-Jan
A report examined patients' views on the use of 'co-payments' or 'top up fees' in the National Health Service, a system whereby patients could decide to pay privately for additional or faster treatment, such as quicker access to diagnostic tests. Based on the findings from a patient survey, the report said that there was clear support for the National Health Service being free at the point of use (89 per cent in favour), but this fell to 69 per cent when respondents were asked to take into consideration economic factors. The report noted that 57 per cent of respondents had said that quality of the care received did not impact on their view on co-payments, and 75 per cent felt that payment for private diagnostic tests should not result in faster testing.
Source: NHS Co-Payments: How popular are they among healthcare users? A survey of patients and their opinions on the use of co-payments and top-up fees in the NHS, Patients Association
Links: Report
Date: 2014-Jan
