The competition watchdog for the National Health Service examined how the rules on competition applied to delivery models aimed at integrating care for patients and service users. It set out the characteristics of the models of delivery of integrated care that were unlikely to fall foul of competition rules and those that were more likely to do so.
Source: The Implications of Competition Rules for the Delivery of Integrated Care, Co-Operation and Competition Panel for NHS-Funded Services
Links: Paper
Date: 2012-Dec
An article examined the extent of integrated working between care homes and primary and community health and social services in England. More integrated working had the potential to improve quality of care in a cost-effective manner: but strategic decisions to create more formal arrangements were required to bring this about. Commissioners of services for older people needed to capitalize on good working relationships and address idiosyncratic patterns of provision to care homes.
Source: Heather Gage, Angela Dickinson, Christina Victor, Peter Williams, Jerome Cheynel, Sue L Davies, Steve Iliffe, Katherine Froggatt, Wendy Martin, and Claire Goodman, 'Integrated working between residential care homes and primary care: a survey of care homes in England', BMC Geriatrics, Volume 12
Date: 2012-Dec
The coalition government outlined plans (following consultation) to increase patient involvement in decisions about their care and treatment. Patients would be able to choose from any provider in England when they were first referred to see a specialist in secondary care. People who used mental health services would, for the first time, have a choice about where and how they received National Health Service treatment.
Source: Liberating the NHS: No Decision about Me without Me – Government Response, Department of Health
Link: Hansard
Note: All links to documents were trashed by Department of Health on the move to its new website in March 2013.
Date: 2012-Dec
A think-tank report said that the new health and well-being boards in the National Health Service could improve integrated care, provide a more democratic approach, and help develop a shared plan for their local populations. But building good relationships and adequate resources would be required if they were to be effective.
Source: Neil Churchill (ed.), Getting Started: Prospects for health and wellbeing boards, Smith Institute
Links: Report
Date: 2012-Dec
The new National Health Service Commissioning Board published guidelines on the incentives and levers that would be used to improve services in England from April 2013. Local poverty rates would no longer be taken into account in the allocation of funding.
Source: Everyone Counts: Planning for patients 2013/14, NHS Commissioning Board
Links: Guidelines | CB press release | Hansard | BMA press release | Kings Fund press release | Labour Party press release | NHS Confederation press release | RCGP press release | RCN press release | RCOG press release | Guardian report | Public Finance report
Date: 2012-Dec
The coalition government published a summary of responses to a consultation on on local authority health scrutiny. It said that respondents had been 'largely positive' about the proposals put forward.
Source: Local Authority Health Scrutiny: A Summary of Consultation Responses, Department of Health
Link: DH press release
Note: All links to documents were trashed by the Department of Health on the move to its new website in March 2013.
Date: 2012-Dec
A study examined the early development of new clinical commissioning groups (CCGs) in the National Health Service in England. There had been 'a great deal of activity and enthusiasm' from leading family doctors on the ground as they engaged with the new structures. Developing structures were 'complicated and multi-layered', as CCGs worked out how relationships between governance structures, operational responsibilities, and 'grass-roots members' would work in the longer term.
Source: Kath Checkland, Anna Coleman, Julia Segar, Imelda McDermott, Rosalind Miller, Andrew Wallace, Christina Petsoulas, Stephen Peckham, and Stephen Harrison, Exploring the Early Workings of Emerging Clinical Commissioning Groups: Final report, Policy Research Unit in Commissioning and the Healthcare System
Links: Report | Summary | PRU press release | Manchester University press release
Date: 2012-Nov
Researchers evaluated the personal health budget pilot programme in England. The use of personal health budgets was associated with a significant improvement in the care-related quality of life and psychological well-being of patients, but did not appear to have an impact on health status as such. The coalition government announced that personal health budgets would be rolled out nationally by 2014.
Source: Julien Forder, Karen Jones, Caroline Glendinning, James Caiels, Elizabeth Welch, Kate Baxter, Jacqueline Davidson, Karen Windle, Annie Irvine, Dominic King, and Paul Dolan, Evaluation of the Personal Health Budget Pilot Programme, Discussion Paper 2840, Personal Social Services Research Unit | Press release 30 November 2012, Department of Health
Links: Paper | DH press release | In Control press release | NHS Confederation press release | RCGP press release | RCN press release | TLAP press release | Turning Point press release | Community Care report
Date: 2012-Nov
An article examined local priority-setting activity across five English primary care trusts. There had been a shift towards more explicit priority-setting, and there was concern in relation to the instrumental effects and the wider legitimacy of priority-setting activities.
Source: Suzanne Robinson, Iestyn Williams, Helen Dickinson, Tim Freeman, and Benedict Rumbold, 'Priority-setting and rationing in healthcare: evidence from the English experience', Social Science & Medicine, Volume 75 Issue 12
Links: Abstract
Date: 2012-Nov
The government began consultation on proposals (from the National Health Service Future Forum) to strengthen the NHS Constitution. The main changes proposed covered:
• A new responsibility for staff to treat patients not only with the highest standards of care but also with compassion, dignity, and respect.
• A new pledge making it explicit that patients could expect to sleep in single-sex wards.
• A new pledge to patients that NHS staff needed to be open and honest with them if things went wrong or mistakes happened – this 'duty of candour' would become a condition in the NHS standard contract from April 2013.
Source: A Consultation on Strengthening the NHS Constitution, Department of Health
Links: Consultation document | Forum letter | Hansard | DH press release | NCPC press release | NHS Confederation press release | Daily Mail report | Public Finance report | Telegraph report
Date: 2012-Nov
The coalition government published its first 'mandate' to the National Health Service Commissioning Board, setting out its ambitions for the health service in England for the 2 years to March 2015. The mandate was structured around key areas where the government expected the Commissioning Board to make improvements:
• Preventing people from dying prematurely.
• Enhancing quality of life for people with long-term conditions.
• Helping people to recover from episodes of ill-health or following injury.
• Ensuring that people had a positive experience of care.
• Treating and caring for people in a safe environment and protecting them from avoidable harm.
Key objectives contained within the mandate included putting mental health on an equal footing with physical health.
Source: The Mandate: A mandate from the government to the NHS Commissioning Board – April 2013 to March 2015, Department of Health
Links: Mandate | Hansard | DH press release | AMS press release | BMA press release | CMH press release | Kings Fund press release | Mencap press release | NCB press release | NCPC press release | NHS Confederation press release | NHS Partners Network press release | Patients Association press release | Turning Point press release | 2020health press release | BBC report | Guardian report
Date: 2012-Nov
A report examined how workforce culture in the National Health Service needed to change to enable co-production between clinicians and patients.
Source: Working towards People Powered Health: Insights from practitioners, National Endowment for Science, Technology and the Arts
Links: Report
Date: 2012-Nov
A think-tank report said that the way in which the National Health Service paid hospitals for the work that they did – including payment by results – should change to incentivize new models of care. Although payment by results had had a positive impact, existing payment systems might be obstructing changes in services required to meet existing and future healthcare needs. The system was not flexible enough to adapt to NHS objectives, which were more geared towards community-based treatment and reduced hospital activity.
Source: John Appleby, Tony Harrison, Loraine Hawkins, and Anna Dixon, Payment by Results: How can payment systems help to deliver better care?, King s Fund
Links: Report | Kings Fund press release | Monitor press release | Public Finance report
Date: 2012-Nov
An audit report said that incentive schemes aimed at improving quality of service in the National Health Service had had a 'variable' impact. Although the concept of 'best practice tariffs' had strong support, NHS organizations said that they were not a driving force for local improvement.
Source: James Peskett, Emma Knowles, Philippa Lynch, John Sandhu, Nelson Johnson, Richard Edwards, and Sarah Halling, Best Practice Tariffs and their Impact, Audit Commission
Links: Report | Summary | Nottingham University press release
Date: 2012-Nov
A think-tank report said that National Health Service funding arrangements encouraged acute hospitals to admit patients to hospital to service high fixed costs for staff and property, rather than trying to treat patients at a community level or in the home. Unnecessary admissions to hospitals had grown over the previous 10 years, fuelled by pay incentives that failed to encourage family doctors and consultants to work together in the best interests of the patient.
Source: Henry Featherstone, Altogether Now: Competitive integration in the NHS, Policy Exchange
Links: Report | Policy Exchange press release
Date: 2012-Nov
A report examined the extent to which patients (or their referring doctors) had been choosing a different location of care since reforms were introduced that offered patients a choice over where they attended a first outpatient appointment, and since the expansion in the number and capacity of independent sector treatment centres (ISTCs). Although in 2010 the majority of patients still received outpatient care from their nearest National Health Service trust, and the volume of patients seen at the nearest trust had increased since 2006-07, there had been a decrease in the proportion of patients attending their nearest NHS trust and an increase in those attending ISTCs.
Source: Elaine Kelly and Gemma Tetlow, Choosing the Place of Care: The effect of patient choice on treatment location in England, 2003–2011, Nuffield Trust
Links: Report | Nuffield Trust press release | IFS press release
Date: 2012-Nov
A report said that too much health and social care was in the wrong place and organized in the wrong way. There was growing concern about the capacity of the National Health Service to sustain a high-quality and safe service. It made a series of recommendations, including calls for:
• A change in the law to create a 'statutory duty of candour' to overcome 'long-standing and persistent culture of secrecy, cover-up and authoritarian management in the NHS'.
• Implementation of the Dilnot Commission reforms as a necessary first step for ensuring sufficient funding for social care.
• Urgent work to ensure that the safety and quality of hospitals did not vary according to how old the patient was or when they were admitted.
• A concerted drive by NHS organisations to involve and listen to patients and carers.
Source: Not the Francis Report, National Voices
Links: Report | National Voices press release | NHS Confederation press release
Date: 2012-Oct
An article examined how much the public said that they wanted choice in the provision of public services, and how far that was related to satisfaction with public services. Citizens said that they wanted choice, and the more they said that they wanted it the less satisfied they were with National Health Service hospital services. However, the claim that citizens valued choice for its own sake was also not supported. Public perceptions of how much choice people had over which hospital they attended were not associated with service satisfaction once perceptions of how much patients were involved in their treatment were taken into account.
Source: John Curtice and Oliver Heath, 'Does choice deliver? Public satisfaction with the health service', Political Studies, Volume 60 Issue 3
Links: Abstract
Date: 2012-Oct
A report said that National Health Service commissioners should use a 'dual carriageway' approach to roll out personal health budgets, ensuring that they complemented arrangements already used in social care. It introduced the idea of joint personal budgets for health and social care.
Source: Joint Personal Budgets: A new solution to the problem of integrated care?, NHS Confederation
Links: Report | NHS Confederation press release
Date: 2012-Oct
The Welsh Government began consultation on the future development of Community Health Councils, following a review.
Source: Patients' Voice for Wales: Proposals following the review of Community Health Councils, Welsh Government | Marcus Longley, Mark Llewellyn, and Amy Simpson, Moving Towards World Class? A review of Community Health Councils in Wales, Welsh Institute for Health and Social Care (University of Glamorgan)
Links: Consultation document | NHS Wales press release | Review report | BBC report
Date: 2012-Oct
A report said that most National Health Service trusts were losing money on their accident and emergency services. The Department of Health should re-examine the policy of paying for some emergency admissions at 30 per cent of the standard tariff. The risks and responsibility for avoiding emergency admissions should be more fairly shared between acute trusts and primary and community care.
Source: Driving Improvement in A&E Services, Foundation Trust Network
Links: Report | Foundation Trust press release | Guardian report
Date: 2012-Oct
A report highlighted wide variations in urgent care services, and called for greater clarity around urgent care commissioning. The term 'urgent care centre' covered a wide range of services, causing confusion among the public, patients, and even health professionals.
Source: David Carson, Henry Clay, and Rick Stern (with Simon Lawrence), Urgent Care Centres: What Works Best?, Primary Care Foundation
Links: Report | PCF press release
Date: 2012-Oct
An article highlighted some of the barriers in England to access to high-quality and appropriate end-of-life care for patients with a non-cancer diagnosis. These related to differences in disease trajectories and subsequent care planning, further entrenched by funding arrangements.
Source: Rachael Addicott, 'Delivering better end-of-life care in England: barriers to access for patients with a non-cancer diagnosis', Health Economics, Policy and Law, Volume 7 Issue 4
Links: Abstract
Date: 2012-Oct
A paper classified 30 developed (OECD) countries' healthcare systems according to a typology that distinguished three core dimensions: regulation, financing, and service provision. A classification according to most recent institutional setting resulted in five healthcare system types: national health service, national health insurance, social health insurance, 'etatist' social health insurance, and private health system.
Source: Katharina Bohm, Achim Schmid, Ralf Gotze, Claudia Landwehr, and Heinz Rothgang, Classifying OECD Healthcare Systems: A deductive approach, TranState Working Paper 165, University of Bremen (Germany)
Links: Paper
Date: 2012-Sep
A report said that just 1 in 100 family doctor practices in the National Health Service were providing patients with electronic health records, despite evidence showing that patients who took up the service secured better health outcomes.
Source: John Cruickshank, Carl Packman, and Jon Paxman, Personal Health Records: Putting patients in control?, 2020health
Links: Report | 2020 press release
Date: 2012-Sep
A briefing paper by corporate finance advisers said that the introduction of family doctor commissioning, and interest in healthcare models offering alternatives to hospital care, would require a higher proportion of services to be delivered by the private sector. The markets for these services were estimated to be worth around £20 billion.
Source: £20 Billion Opportunity Ahead for the Private Sector, Catalyst Corporate Finance
Links: Paper | Catalyst press release | Guardian report
Date: 2012-Sep
A think-tank report said that mergers of failing hospitals should be halted because this approach only worsened problems. Private firms and successful National Health Service trusts should instead be encouraged to step in when hospitals were in trouble.
Source: Paul Corrigan, John Higton, and Simon Morioka, Takeover: Tackling failing NHS hospitals, Reform
Links: Report | NHS Confederation press release | Public Finance report
Date: 2012-Sep
A report said that the demand on hospital services was increasing to the point where acute care could not keep pace in its existing form. There were one-third fewer general and acute beds than there had been 25 years previously: but the previous decade alone had seen a 37 per cent increase in emergency admissions. This was coupled with a change in patients' needs: nearly two-thirds (65 per cent) of people admitted to hospital were over 65 years old, and an increasing number were frail or had a diagnosis of dementia. Hospital buildings, services, and staff were often not equipped to deal with those with multiple, complex needs.
Source: Hospitals on the Edge? The time for action, Royal College of Physicians
Links: Report | RCP press release | Labour Party press release | NHS Confederation press release | Patients Association press release | RCOG press release | Guardian report | Public Finance report | Telegraph report
Date: 2012-Sep
A study identified research evidence on commissioning (or public service purchasing) in education, health, and/or social welfare; and investigated the impact of joint commissioning.
Source: Mark Newman, Mukdarut Bangpan, Naira Kalra, Nicholas Mays, Irene Kwan, and Tony Roberts, Commissioning in Health, Education and Social Care: Models, research bibliography and in-depth review of joint commissioning between health and social care agencies, Report 2007, EPPI-Centre (Institute of Education/University of London)
Date: 2012-Sep
A report said that patients wanted to be more involved in their care, but felt that family doctors were not delivering good communication or shared decision-making. Patients too often felt disempowered and disengaged, and reported feeling patronized. When patients raised concerns, nearly 1 in 4 felt that the response was poor – and 4.4 per cent said that they had been removed from their family doctor's list after making a complaint.
Source: Patients and GPs – Partners in Care, Patients Association
Links: Report | Patients Association press release | Telegraph report
Date: 2012-Sep
A report examined the potential impact on healthcare systems in the European Union of the application of free movement rules and increased patient mobility.
Source: Rita Baeten, Europeanization of National Health Systems: National impact and EU codification of the patient mobility case law, European Social Observatory (Brussels)
Links: Report
Date: 2012-Sep
A think-tank report examined how the existing health and social care delivery system had failed to keep pace with the population's needs and expectations. Incremental changes to existing models of care would not be sufficient in addressing these challenges, and a much bolder approach was needed – one bringing about innovative models that were appropriate to the needs of the population and were high quality, sustainable, and offered value for money.
Source: Chris Ham, Anna Dixon, and Beatrice Brooke, Transforming the Delivery of Health and Social Care: The case for fundamental change, King's Fund
Links: Report | Summary | NHS Confederation press release | RCN press release
Date: 2012-Sep
An article examined the allocation of responsibility for key healthcare policy tasks and policy areas in European countries. The allocation of powers broadly followed 'fiscal federalism'.
Source: Christopher Adolph, Scott Greer, and Elize Massard da Fonseca, 'Allocation of authority in European health policy', Social Science & Medicine, Volume 75 Issue 9
Links: Abstract
Date: 2012-Aug
A report said that older people in Wales were missing out on the essential services they needed to recover after a stay in hospital because of confusion around what constituted reablement services.
Source: Ed Bridges and Vicki James, Getting Back on Your Feet: Reablement in Wales, WRVS
Links: Report | WRVS press release | BBC report
Date: 2012-Aug
A think-tank report said that 7,000 fewer emergency hospital beds would be needed by the National Health Service if all areas of England achieved the rate of admission and average length of stay for over-65s as those with the lowest use. This equated to a potential opportunity to reduce the number of overnight stays by 2.3 million per year and to reinvest £462 million a year in community and primary care services.
Source: Candace Imison, Emmi Poteliakhoff, and James Thompson, Older People and Emergency Bed Use: Exploring variation, King s Fund
Links: Report | Kings Fund press release | BBC report | Guardian report
Date: 2012-Aug
An article mapped what was known about the determinants of patient choice for a wide range of healthcare providers. There was no such thing as the typical patient: different patients made different choices in different situations. Comparative information seemed to have a relatively limited influence on the choices made by many patients, and patients based their decisions on a variety of provider characteristics instead of solely on outcome. The assumptions made in health policy about patient choice might therefore be an oversimplification of reality.
Source: Aafke Victoor, Diana Delnoij, Roland Friele, and Jany Rademakers, 'Determinants of patient choice of healthcare providers: a scoping review', BMC Health Services Research, Volume 12
Date: 2012-Aug
A report compared different payment systems for healthcare used across Europe, and examined their role in improving the efficiency and quality of care. Rather than a single payment system such as 'pay for performance' or diagnosis-related groups, blended payment systems had repeatedly been found to contribute to the delivery of high-quality, affordable care.
Source: Anita Charlesworth, Alisha Davies, and Jennifer Dixon, Reforming Payment for Health Care in Europe to Achieve Better Value, Nuffield Trust
Date: 2012-Aug
An article compared the types of benefit considered relevant by the Department of Health with those used by the National Institute for Health and Clinical Excellence (NICE) when conducting economic evaluations of options for spending healthcare resources. The Department and NICE approached resource allocation in different ways, based on overlapping but not congruent principles. There was a case for establishing a uniform framework for option appraisal and priority setting so as to avoid allocative inefficiency.
Source: Koonal Shah, Cecile Praet, Nancy Devlin, Jonathan Sussex, John Appleby, and David Parkin, 'Is the aim of the English health care system to maximize QALYs?', Journal of Health Services Research and Policy, Volume 17 Number 3
Links: Abstract
Date: 2012-Jul
The report of an independent forum put forward a series of proposals for improving health-related care for children and young people.
Source: Report of the Children and Young People's Health Outcomes Forum, Department of Health
Links: Report | DH press release | NCB press release | NHS Confederation press release | RCM press release | YoungMinds press release
Date: 2012-Jul
The coalition government published a report that examined the effect of the new National Health Service constitution. It considered whether, and to what extent, the constitution had made a difference to patients, staff, carers, and the public; and examined the degree to which it was succeeding in its aims. Public awareness of the constitution remained generally low and there was little evidence that patients used it as a means of exercising their rights. Staff awareness was significantly higher than among the public: nonetheless few felt well informed about it.
Source: Report on the Effect of the NHS Constitution, Department of Health
Links: Report | Hansard | DH press release
Date: 2012-Jul
A professional organization for family doctors said that personal health budgets 'might have the potential, under the right circumstances' to provide benefits for 'some' patients: but their implementation in England posed a number of challenges that the government had not adequately addressed. There should be a delay while evidence from pilot studies was evaluated.
Source: Nigel Mathers, Mark Thomas, and Vanita Patel, Personal Health Budgets, Royal College of General Practitioners
Links: Statement
Date: 2012-Jul
A report said that private equity had not led to service disruption in social care, and could prove a vital source of investment in future years.
Source: The Role of Private Equity in UK Health & Care Services, Laing & Buisson
Links: Report | L&B press release | Community Care report
Date: 2012-Jul
A report examined progress by the new clinical commissioning groups in the National Health Service in England. It included 12 case studies. It said that there had been 'real progress' in improving services for patients.
Source: Clinical Commissioning in Action, NHS Clinical Commissioners
Links: Report
Notes: Clinical commissioning groups – representing local doctors, nurses, and patients – will formally replace primary care trusts from April 2013.
Date: 2012-Jul
An article examined new governance arrangements for National Health Service foundation trusts. It said that the trusts had failed to deliver social ownership and local accountability. Policy-makers should re-frame the governance apparatus associated with mutualism and social ownership in terms of the concept of 'meta-regulation'. This would help to steer foundation trusts towards sustainable forms of compliance via non-coercive, non-intrusive means.
Source: John Wright, Paul Dempster, Justin Keen, Pauline Allen, and Andrew Hutchings, 'The new governance arrangements for NHS foundation trust hospitals: reframing governors as meta-regulators', Public Administration, Volume 90 Issue 2
Links: Abstract
Date: 2012-Jul
The coalition government published an annual report on the National Health Service in England for 2011–12.
Source: The National Health Service and Public Health Service in England: Secretary of State s Annual Report 2011/2012, Cm 8373, Department of Health, TSO
Links: Report | Hansard | DH press release
Date: 2012-Jul
The government began consultation on the overall objectives of the new NHS Commissioning Board (from 2013). The objectives covered five domains:
• Preventing premature deaths – helping people live longer.
• Supporting people with a long-term condition to look after themselves.
• Supporting people through their recovery from episodes of ill-health or injury.
• Making sure that people had a positive experience of care in the NHS.
• Treating people in a clean, safe, environment; and protecting them from unnecessary harm.
Source: Our NHS Care Objectives: A draft mandate to the NHS Commissioning Board, Department of Health | Developing Our NHS Care Objectives: A consultation on the draft mandate to the NHS Commissioning Board, Department of Health
Links: Draft mandate | Consultation document | Hansard | DH press release | In Control press release | Mind press release | NHS Confederation press release | RCP press release
Date: 2012-Jul
An article said that European Union health policy exemplified the philosophical tension between economic freedoms and social policy. EU competition law, like other internal market rules, could restrict national health policy options despite the subsidiarity principle. In particular, European health system reforms that incorporated elements of market competition might trigger the application of competition rules if non-economic gains in consumer welfare were not adequately accounted for. The authors drew on a sample of cases to analyze how the European Court of Justice, national courts, and national competition authorities had applied competition laws to the health services sector in different circumstances and in different ways. It concluded by considering the implications of the convergence of recent trends in competition law enforcement and health system market reforms.
Source: Elias Mossialos and Julia Lear, 'Balancing economic freedom against social policy principles: EC competition law and national health systems', Health Policy, Volume 106 Issue 2
Links: Abstract
Date: 2012-Jun
An article examined gender mainstreaming in national healthcare systems in England and Germany.
Source: Ellen Kuhlmann and Ellen Annandale, 'Mainstreaming gender into healthcare: a scoping exercise into policy transfer in England and Germany', Current Sociology, Volume 60 Number 4
Links: Abstract
Date: 2012-Jun
An article examined the impact of gatekeeping and provider choice on efficiency, costs, quality, equality, and patient empowerment in healthcare in developed (OECD) countries. There was a diverging trend of reforms, with some traditionally restrictive countries offering more provider choice and other countries limiting the choice of providers as a result of managed care reforms.
Source: Nadine Reibling and Claus Wendt, 'Gatekeeping and provider choice in OECD healthcare systems', Current Sociology, Volume 60 Number 4
Links: Abstract
Date: 2012-Jun
A report examined outsourcing in the National Health Service. Too many in the NHS viewed the private sector with suspicion. The private sector (notably, family doctors) had been part of the NHS since its inception. The values of private contractors were not in conflict with either the existence or the objectives of the NHS.
Source: Nick Carley, Strategic Outsourcing in the NHS: Beyond ideology and money?, Alterline Research
Links: Link removed
Date: 2012-Jun
An article said that European Union healthcare services policy had been largely driven by the European Court of Justice applying the law of the internal market to the previously separate area of healthcare systems. This opened up two major risks: that health service planning would be disrupted by cross-border flows of patients and professionals, including ostensibly interchangeable professionals or procedures that actually varied in quality; and that health systems would be disrupted by the application of liberalizing EU regulatory frameworks. Member states had implemented a strategy of 'bureaucratic resistance', limiting effects on systems and regulations alike.
Source: Scott Greer and Holly Jarman, 'Managing risks in EU health services policy: spot markets, legal certainty and bureaucratic resistance', Journal of European Social Policy, Volume 22 Number 3
Links: Abstract
Date: 2012-Jun
A new book examined the role of knowledge production and technology in recent changes in the organization of healthcare. It focused on the market (attempts to embed principles of economic rationality and efficient use of resources in the shaping and delivery of healthcare); the laboratory (science, experiments, and 'evidence' in the management of research, practice, and policy); and the forum (the application of deliberative procedures and other forms of public consultation to healthcare decision-making).
Source: Tiago Moreira, The Transformation of Contemporary Health Care: The market, the laboratory, and the forum, Routledge
Links: Summary
Date: 2012-Jun
A report said that delivering healthcare closer to people's homes could lead to £3.4 billion of annual savings to the National Health Service, as well as significantly enhanced patient outcomes. It called for a new approach to home and community care services, and said that the hospital regulator should review the financial incentives and disincentives that affected the length of hospital stays.
Source: The Right Care in the Right Place: Delivering care closer to home, Confederation of British Industry
Links: Report | CBI press release
Date: 2012-Jun
An article drew on interviews with primary care doctors in England and California to highlight the emergence of new strata or elites in primary care, with groups of doctors involved in both surveillance of others and action to improve compliance in deficient individuals and organizations.
Source: Ruth McDonald, 'Restratification revisited: the changing landscape of primary medical care in England and California', Current Sociology, Volume 60 Number 4
Links: Abstract
Date: 2012-Jun
A report outlined some of the ways in which the National Health Service in Wales needed to adapt in order to become genuinely patient-centred.
Source: Jan Davies, Bernadette Fuge, Abigail Harris, Peter Barrett-Lee, and Jon Matthias, Person Driven Care: A study of The Esther Network in Sweden and the lessons that can be applied to enable NHS Wales to become a patient-centred healthcare system, 1000 Lives Plus
Links: Report | NHS Wales press release
Date: 2012-May
The Scottish Government began consultation on its proposals to integrate adult health and social care services.
Source: Integration of Adult Health and Social Care in Scotland: Consultation on Proposals, Scottish Government
Links: Consultation document
Date: 2012-May
An article examined acquisition deals targeting healthcare provider organizations in western Europe between 1990 and 2009, focusing on the role of financial services organizations as acquirers. The findings suggested a penetration of private capital into healthcare provision that might be interpreted as a specific form of privatization, as well as pointing to the rising internationalization of healthcare.
Source: Federica Angeli and Hans Maarse, 'Mergers and acquisitions in western European health care: exploring the role of financial services organizations', Health Policy, Volume 105 Issue 2/3
Links: Abstract
Date: 2012-May
A report examined the impact of outsourcing on the delivery of National Health Service services. Much of the evidence demonstrated either the negative aspects of introducing competition into the provision of healthcare services or inconclusive results. A lack of data made it difficult to assess the impact of contracted-out services on accessibility of services and health outcomes. Overall, there was a lack of evidence to show that outsourcing led to improved quality of patient care. The experience of outsourcing cleaning services showed that there was a negative impact on patient care. Outsourcing of clinical services showed some negative effects on patient care, poor value for money, and inadequate monitoring and evaluation. Although there was some evidence of the benefits of shared services, the experience of the NHS information technology project was a clear failure of outsourcing.
Source: Jane Lethbridge, Empty Promises: The impact of outsourcing on the delivery of NHS services, Unison
Links: Report
Date: 2012-May
An article examined variations in the use of preventive health services by people aged 50 and over in 14 European countries (including the United Kingdom). There were significant variations both within and between European countries. In all countries, higher-educated and higher-income groups used more preventive services. At the health system level, high public health expenditures and high family doctor density were associated with a high level of preventive care use: but specialist density did not appear to have any effect. Payment schemes for family doctors and specialists appeared to significantly affect the incentives to provide preventive healthcare: in systems where doctors were paid by fee-for-service, the utilization of all health services, including cancer screening, was higher.
Source: Florence Jusot, Zeynep Or, and Nicolas Sirven, 'Variations in preventive care utilisation in Europe', European Journal of Ageing, Volume 9 Number 1
Links: Abstract
Date: 2012-May
An article examined the difficulties that had been experienced in making commissioning work in the National Health Service in England. Far from reflecting managerial incompetence, some of the difficulties were inherent in the normative and cultural/cognitive pillars of the NHS, so that there was a lack of 'fit' between commissioning and the institutional characteristics of the NHS.
Source: Kath Checkland , Stephen Harrison, Stephanie Snow, Imelda McDermott, and Anna Coleman, 'Commissioning in the English National Health Service: what's the problem?', Journal of Social Policy, Volume 41 Issue 3
Links: Abstract
Date: 2012-May
A briefing paper examined the factors that promoted, and hindered, joint working between health and social care services. There was a significant overlap between positive and negative factors, with many of the organizational factors identified in research as promoting joint working also being identified as hindering collaboration when insufficient attention was paid to their importance. Securing the understanding and commitment of staff to the aims and desired outcomes of new partnerships was crucial to the success of joint working, particularly among health professionals.
Source: Ailsa Cameron, Rachel Lart, Lisa Bostock, and Caroline Coomber, Factors that Promote and Hinder Joint and Integrated Working Between Health and Social Care Services, Research Briefing 41, Social Care Institute for Excellence
Links: Paper
Date: 2012-May
A think-tank report said that a new style of leadership in the National Health Service could deliver lower mortality, better patient experience and outcomes, and financial savings. It highlighted the links between organizational performance and leaders who engaged staff, patients, and others in improving care.
Source: Edwina Rowling (ed.), Leadership and Engagement for Improvement in the NHS: Together we can, King s Fund
Links: Report | Kings Fund press release | NHS Confederation press release | Guardian report
Date: 2012-May
The coalition government published a 10-year information strategy for the National Health Service, public health, and social care. It included a commitment that people would be able to access their family doctor records online by 2015.
Source: The Power of Information: Putting all of us in control of the health and care information we need, Department of Health
Links: Strategy | Hansard | DH press release | ADASS press release | Alzheimers Society press release | BMA press release | Kings Fund press release | NCB press release | NHS Alliance press release | NHS Confederation press release | RCP press release | RPS press release
Date: 2012-May
A report by a committee of MSPs said that the voluntary sector and independent providers of care should have a greater role in delivering integrated health and social care.
Source: Inquiry Into Integration of Health and Social Care, 5th Report 2012, SP Paper 121, Scottish Parliament Health and Sport Committee
Links: Report | Scottish Parliament press release
Date: 2012-May
An article examined leadership and governance arrangements in seven developed health systems in Europe (including England) and Australia. It considered three fundamental functions: priority setting, performance monitoring, and accountability arrangements. Approaches to leadership and governance varied substantially, and had thus far been developed piecemeal and somewhat arbitrarily. A judicious mix of accountability mechanisms was likely to be appropriate in most settings – including market mechanisms, electoral processes, direct financial incentives, and professional oversight and control. These mechanisms should be aligned with the priority-setting and monitoring processes.
Source: Peter Smith, Anders Anell, Reinhard Busse, Luca Crivelli, Judith Healy, Anne Karin Lindahl, Gert Westert, and Tobechukwu Kene, 'Leadership and governance in seven developed health systems', Health Policy, Volume 106 Issue 1
Links: Abstract
Date: 2012-May
An article critically examined the approach taken by the European Court of Justice regarding the application of the internal market principles (or market freedoms) to the field of healthcare services.
Source: Danielle da Costa Leite Borges, 'European health systems and the internal market: reshaping ideology?', Health Care Analysis, Volume 19 Number 4
Links: Abstract
Date: 2012-Apr
A think-tank report said that new health and well-being boards in the National Health Service could be the catalyst for delivering integrated care, by bringing together public health and local authorities to co-ordinate health and other local services. The report identified 'real optimism' on the part of the shadow boards about the prospects for success – with almost all those surveyed expecting boards to deliver on their identified priorities and promote closer integration between the National Health Service and local authorities.
Source: Richard Humphries, Amy Galea, Lara Sonola, and Claire Mundle, Health and Wellbeing Boards: System Leaders or Talking Shops?, King s Fund
Links: Report | Kings Fund press release | Charity Times report
Date: 2012-Apr
The coalition government set out the strategic objectives for the new National Health Service Commissioning Board Authority. The objectives related to: transferring power to local organizations; establishing the commissioning landscape; developing specific commissioning and financial management capabilities; and developing excellent relationships.
Source: Letter 23 April 2012, Department of Health
Links: Letter | DH press release
Date: 2012-Apr
An article examined the claim by the former Labour government (1997-2010) that National Health Service foundation trusts (FTs) were mutual organizations. It said that FTs were not in fact mutuals, because they continued to be owned by the state. Moreover, the staff of FTs were generally not engaging with the new governance structures. In general, there was mixed experience of the new structures enabling governors to increase accountability of the hospitals to the public. On the other hand, having a membership did enhance the legitimacy of FTs, as opposed to other NHS organizations.
Source: Pauline Allen, Jean Townsend, Paul Dempster, John Wright, Andrew Hutchings, and Justin Keen, 'Organizational form as a mechanism to involve staff, public and users in public services: a study of the governance of NHS foundation trusts', Social Policy and Administration, Volume 46 Number 3
Links: Abstract
Date: 2012-Apr
A new book examined a range of issues connected with interprofessional working in health and social care.
Source: Georgina Koubel and Hilary Bungay (eds.), Rights, Risks and Responsibilities: Interprofessional working in health and social care, Palgrave Macmillan
Links: Summary
Date: 2012-Mar
An article examined the impact of provider diversity on quality and innovation in the English National Health Service by identifying the differences in performance between third sector organizations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS. Private providers showed greater concern to improve patient pathways and patient experience, whereas TSOs delivered quality improvements by using a more holistic approach and a greater degree of community involvement. There was scope to increase the participation of diverse providers: but care needed to be taken not to damage public accountability, overall productivity, equity, and NHS providers (especially acute hospitals).
Source: Pauline Allen, Simon Turner, Will Bartlett, Virginie Perotin, Greenwell Matchaya, and Bernarda Zamora, 'Provider diversity in the English NHS: a study of recent developments in four local health economies', Journal of Health Services Research and Policy, Volume 17 Supplement 1
Links: Abstract
Date: 2012-Mar
An article examined the extent to which service line reporting (a system of financial management and control) had been introduced into one National Health Service foundation trust, and what achievements had been made to date. It also considered the extent to which the service line reporting approach aligned with modern thinking about budgetary systems.
Source: Donald Harradine and Malcolm Prowle, 'Service line reporting in a National Health Service foundation trust: an initial assessment of its relevance and applicability', Public Money and Management, Volume 32 Issue 3
Links: Abstract
Date: 2012-Mar
A briefing paper examined the evidence base for health and social care integration. It said that there was clear evidence that structural integration did not deliver effective service improvement; and that there was as yet no robust evidence for positive financial benefits from integration.
Source: Alison Petch, Integration of Health and Social Care, Institute for Research and Innovation in Social Services
Links: Paper
Date: 2012-Mar
The final report was published of a two-year independent study of integrated care pilots. The evaluation looked at 16 sites across England that undertook different ways of integrating care – for example, between general practices, community nurses, hospitals, and social services.
Source: RAND Europe and Ernst & Young LLP, National Evaluation of the Department of Health s Integrated Care Pilots: Final Report, Department of Health
Links: Report | Summary | Appendices | Community Care report
Date: 2012-Mar
A new book examined the interrelationship between human rights law in Europe and a wide range of health issues – including access to healthcare, health data protection, the quality of pharmaceutical drugs, and medical-ethical issues such as abortion and euthanasia.
Source: Brigit Toebes, Mette Hartlev, Aart Hendriks, and Janne Rothmar Herrmann (eds.), Health and Human Rights in Europe, Intersentia
Links: Summary
Date: 2012-Mar
An article examined the reform under which more autonomy was given to better-performing National Health Service hospitals in England. Despite being enmeshed in a politicized culture of regulations and guidance, autonomy was increasingly perceived positively, and appeared to depend on the extent to which organizations had the incentives and the capacity to respond.
Source: Paul Anand, Mark Exworthy, Francesca Frosini, and Lorelei Jones, 'Autonomy and improved performance: lessons from an NHS policy reform', Public Money and Management, Volume 32 Issue 3
Links: Abstract
Date: 2012-Mar
An article examined the background to the policy shift towards personalization of health and social care; assessed the 'limited' research evidence for personalization; and identified themes for future policy research.
Source: Jason Powell, 'Personalization and community care: a case study of the British system', Ageing International, Volume 37 Number 1
Links: Abstract
Date: 2012-Feb
A draft commission report set out a series of recommendations for hospitals and care homes to help them tackle the underlying causes of undignified care of older people. The criteria used for selecting and appraising staff should give the same emphasis to their assessed values and capacity to engage with older people as to their formal qualifications.
Source: Commission on Dignity in Care for Older People, Delivering Dignity: Securing dignity in care for older people in hospitals and care homes – A report for consultation, NHS Confederation/Local Government Association/Age UK
Links: Report | NHS Confederation press release | Alzheimers Society press release | BASW press release | BGS press release | GMC press release | Labour Party press release | LGA press release | NCPC press release | RCN press release | RCP press release | Community Care report | Guardian report | Public Finance report
Date: 2012-Feb
A paper examined key issues associated with the size and configuration of the new National Health Service clinical commissioning groups proposed by the coalition government.
Source: Clinical Commissioning Groups: Size, Shape and Securing Localism, NHS Alliance/National Association of Primary Care
Links: Paper
Date: 2012-Feb
An article examined the impact of devolution on the development and implementation of policies related to patient choice in healthcare. 'Distinct rhetorical differences' were identifiable at a national policy level: but these were less visible at the level of service organization and in the way choices were provided to patients.
Source: Stephen Peckham, Nicholas Mays, David Hughes, Marie Sanderson, Pauline Allen, Lindsay Prior, Vikki Entwistle, Andrew Thompson, and Huw Davies, 'Devolution and patient choice: policy rhetoric versus experience in practice', Social Policy and Administration, Volume 46 Number 2
Links: Abstract
Date: 2012-Feb
A study found that the information underpinning the reimbursement system for National Health Service-funded care needed 'significant improvement'. There were unexplained variations in the unit costs for the same services between providers. There were also areas where data quality was poor, making it impossible to know whether cost variation was genuine, due to data quality, or due to differences in how organizations undertook their costing.
Source: PricewaterhouseCoopers, An Evaluation of the Reimbursement System for NHS-Funded Care, Monitor
Links: Report | Monitor press release
Date: 2012-Feb
An article examined the results of hospital reconfiguration, based on three case studies in the English National Health Service. Differences in implementation between the three cases reflected the nature of the proposed changes and local politics, rather than the strength of the evidence for change. National policy had tended to over-emphasize the importance of consultation using evidence, and had underplayed these influencing factors.
Source: Naomi Fulop, Rhiannon Walters, Perri 6, and Peter Spurgeon , 'Implementing changes to hospital services: factors influencing the process and "results" of reconfiguration', Health Policy, Volume 104 Issue 2
Links: Abstract
Date: 2012-Feb
A paper examined the relationship between individual patients and the health service. The model of a consumer was problematic within free-at-point-of-use health services. 'Baby boomers' and their children had higher expectations of public services than their parents. Engaging people at all levels of the service would increase productivity, improve outcomes, and put service quality on display.
Source: An Uneasy Consensus: Patients, citizens and the NHS, NHS Confederation
Links: Paper
Date: 2012-Feb
A report said that creating a new co-production model – with local government at the heart of orchestrating partnerships – was the best way to deliver better health and well-being outcomes at the local level in the context of 'budget constraint'.
Source: Co-production For Health: A new model for a radically new world – Building new approaches to delivery to achieve better health outcomes at the local level, Solutions for Public Health (National Health Service)
Links: Report | SPH press release
Date: 2012-Feb
An article examined recent European Union laws on advanced therapy medicinal products (a new legal category of medical product in regenerative medicine), and how two national regimes (France and the United Kingdom) regulated ATMPs that did and did not fall under the scope of EU regulation.
Source: Aurelie Mahalatchimy, Emmanuelle Rial-Sebbag, Virginie Tournay, and Alex Faulkner, 'The legal landscape for advanced therapies: material and institutional implementation of European union rules in France and the United Kingdom', Journal of Law and Society, Volume 39 Number 1
Links: Abstract
Date: 2012-Feb
A think-tank report examined the feasibility, and the advantages and disadvantages, of setting out explicitly what level of care National Health Service patients were entitled to, in the form of a nationally specified 'benefits package'. It outlined the existing system (in which decisions regarding treatments were arrived at implicitly) and made recommendations for how it could be improved. These included: establishing a set of principles that would shape how public money was spent in the NHS; producing a national list of the treatments that the NHS would normally fund; and ensuring that decision-making by clinical commissioning groups was transparent.
Source: Benedict Rumbold, Vidhya Alakeson, and Peter Smith, Rationing Health Care: Is it time to set out more clearly what is funded by the NHS?, Nuffield Trust
Date: 2012-Feb
A discussion paper explored personal health budgets for people receiving National Health Service continuing healthcare.
Source: Personal Health Budgets and NHS Continuing Healthcare, Department of Health
Links: Paper | DH press release
Date: 2012-Jan
An article examined the introduction of policies to promote or strengthen patient choice in 4 northern European countries – Denmark, England, the Netherlands, and Sweden. There seemed to be convergence among these countries in the overall policy rhetoric about the objectives associated with patient choice, embracing both concepts of empowerment (the intrinsic value) and market competition (the instrumental value). The institutional context and policy concerns (such as waiting times) had been important in affecting the timing of the introduction of choice policies and implementation: but less so in the design of choice policies.
Source: Karsten Vrangbaek, Ruth Robertson, Ulrika Winblad, Hester Van de Bovenkamp, and Anna Dixon, 'Choice policies in northern European health systems', Health Economics, Policy and Law, Volume 7 Special Issue 1
Links: Abstract
Date: 2012-Jan
The coalition government announced a series of measures designed to improve nursing care in hospitals in England. Nurses would be freed from 'non-essential paperwork and excessive bureaucracy' so that they could spend more time with patients. A new Nursing Quality Forum would look at how the best nursing practice could be spread throughout the National Health Service, and how nursing leadership on hospital wards could be strengthened. A new patient-led inspection regime would also be established, covering food, privacy, cleanliness, and dignity.
Source: Press release 6 January 2012, Department of Health
Links: DH press release | Conservative Party press release | Labour Party press release | RCP press release | Unison press release | BBC report | Nursing Times report
Date: 2012-Jan
An article related the rise of the 'regulatory state' to the path-dependent trajectories and institutional legacies of discrete European healthcare systems. Although the three countries examined faced similar problems of multilevel governance of networks of third-party payers and providers, each system also gave rise to its own distinct regulatory challenges.
Source: Jan-Kees Helderman, Gwyn Bevan, and George France, 'The rise of the regulatory state in health care: a comparative analysis of the Netherlands, England and Italy', Health Economics, Policy and Law, Volume 7 Special Issue 1
Links: Abstract
Date: 2012-Jan
An article examined the development of health technology assessment in Europe, and its impact on policy and practice – with a focus on England, France, Germany, and Sweden.
Source: Corinna Sorenson and Kalipso Chalkidou, 'Evolution of health technology assessment in Europe', Health Economics, Policy and Law, Volume 7 Special Issue 1
Links: Abstract
Date: 2012-Jan
An article examined the motivation for introducing activity-based funding for hospitals in European countries. The evidence available suggested that activity-based funding had been associated with an increase in activity, a decline in length of stay, and/or a reduction in the rate of growth in hospital expenditure in most of the countries under consideration.
Source: Jacqueline O'Reilly, Reinhard Busse, Unto Hakkinen, Zeynep Or, Andrew Street, and Miriam Wiley, 'Paying for hospital care: the experience with implementing activity-based funding in five European countries', Health Economics, Policy and Law, Volume 7 Special Issue 1
Links: Abstract
Date: 2012-Jan
A report examined the ethical challenges posed by factoring environmental outcomes into different levels of health and social care decision-making, including resource allocation and treatments.
Source: Gary Cox and Catherine Max, The Ethics of Sustainable Health and Social Care: Towards a framework for decision-making, Report 51, Social Care Institute for Excellence
Links: Report
Date: 2012-Jan
A new textbook examined commissioning in health and social care. It said that policy aspirations often outstripped the infrastructure needed to support commissioners as they took difficult decisions about future services.
Source: Jon Glasby (ed.), Commissioning for Health and Well-Being: An introduction, Policy Press
Links: Summary | Guardian report
Date: 2012-Jan
A think-tank briefing examined the use of hospital beds for emergency admissions. More than 70 per cent of hospital bed days were accounted for by emergency admissions: using the beds more efficiently could save large sums of money and deliver benefits for patients. There was a particular need to cut the small but disproportionate number of old and very old patients who arrived as emergencies but ended up staying for at least a fortnight.
Source: Emmi Poteliakhoff and James Thompson, Emergency Bed Use: What the Numbers Tell Us, King s Fund
Links: Briefing | Guardian report
Date: 2012-Jan
A think-tank report said that service-line management – under which a hospital trust was divided into specialist clinical areas that were managed as distinct operational units – offered an important approach to improving quality and productivity by giving clinical leaders a clearer understanding of the cost and performance of services.
Source: Catherine Foot, Lara Sonola, Jo Maybin, and Chris Naylor, Service-Line Management Can it improve quality and efficiency?, King s Fund
Links: Report | Kings Fund press release
Date: 2012-Jan
An article examined a European Union Directive that provided a legal framework for cross-border healthcare. The impact of the Directive reached far beyond patient mobility: it created patients' rights, dealt with the quality and safety of healthcare services, and created an 'excessive structure' of co-operation in the field of healthcare.
Source: Miek Peeters, 'Free movement of patients: Directive 2011/24 on the application of patients' rights in cross-border healthcare', European Journal of Health Law, Volume 19 Number 1
Links: Abstract
Date: 2012-Jan
A joint inspectorate report said that health and social care services in Wales needed to improve joint working with other partners in order to shift the focus of care to health promotion, prevention, well-being, and empowerment for older people.
Source: Growing Old My Way: Review of the impact of the National Service Framework (NSF) for Older People in Wales, Healthcare Inspectorate Wales/Care and Social Services Inspectorate Wales
Links: Report | Inspectorate press release
Date: 2012-Jan
An independent forum of health experts published a second set of recommendations designed to improve the quality of patient care and achieve better outcomes. Four separate reports covered: better integration of services; workforce education and training; access to information; and the National Health Service's role in public health. The coalition government said that it accepted the recommendations.
Source: Integration, NHS Future Forum | Education and Training – Next Stage, NHS Future Forum | Information, NHS Future Forum | The NHS s Role in the Public's Health, NHS Future Forum
Links: Report (1) | Report (2) | Report (3) | Report (4) | Summary | Forum press release | DH press release | BMA press release | CMH press release | LGA press release | NHS Confederation press release | Nuffield Trust press release | RCM press release | RCN press release | BBC report | Public Finance report | Telegraph report
Date: 2012-Jan
A commission report said that competition at regulated prices had improved the quality of some areas of the National Health Service in England, and that there was no evidence that it had hampered integration of services. It recommended 'careful expansion' of competition between providers of NHS-funded healthcare. Three background papers were released at the same time.
Source: Competition in the NHS, Commission on Competition in the NHS/Office of Health Economics | Julien Forder and Stephen Allan, Competition in the Care Homes Market, Office of Health Economics | Rosalind Goudie and Maria Goddard, Review of Evidence on What Drives Economies of Scope and Scale in the Provision of NHS Services, Focusing on A&E and Associated Hospital Services, Office of Health Economics | Arik Mordoh, Critical Review of the Quality and Competition Measures and Identification Strategies Used in Health Care Studies, Office of Health Economics
Links: Report | OHE press release | Background paper (1) | Background paper (2) | Background paper (3) | NHS Confederation press release
Date: 2012-Jan
A report said that medical care delivered by fully trained consultant doctors had demonstrable benefits in a range of areas including: rapid and appropriate decision-making; improved outcomes for patients; and more efficient use of resources. The benefits of consultant-delivered care needed to be taken into account alongside cost implications when considering the future shape of the medical workforce at local and national level.
Source: The Benefits of Consultant-Delivered Care, Academy of Medical Royal Colleges
Links: Report | AMRC press release
Date: 2012-Jan
