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Author Archives: Steve Iliffe

Liverpool activist Greg Dropkin has weighed the claims of the RightCare initiative, and found them wanting.  (RightCare: wrong answers Journal of Public Health November 2017). RightCare is an NHS England programme that identifies opportunities for savings and quality improvements and describes itself as ‘a proven approach that delivers better patient outcomes’. Greg Dropkin’s challenges the modelling assumptions made by RightCare (which have a flavour of a corporate consultancy about them), and the misinterpretation of dissimilar outcomes as opportunities for improvement. The difficulties of measuring unwarranted variation are well documented by Appleby and others in a 2011 Kings Fund report (Variations in […]
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Now the Labour Party’s objectives for the NHS are clearer, the real politics begins. If May’s government collapses, as looks increasingly possible, Labour will need to project its tactical policies for the NHS forcefully. The plausibility of how it plans to cope with the winter bed crisis will matter – what will the £500 million promised be spent on? How will a Labour Secretary of State for Health manage delayed transfers of care? If May’s government survives Labour will have to live with Hunt Supremacy for a while longer, and will need some practical ideas. Two events in the last […]
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A seminar on Sustainability &Transformation Partnerships in London, held at the King’s Fund on September 12th, voiced the most serious concerns yet from within the political elite about the viability of STPs. As I understood it the King’s Fund’s report contained seven warnings (as well as a job description for a London Mayor with an interest in the NHS). The warnings were: Providing more community-based care is right but the NHS needed to be realistic about what could be achieved in a short time with limited resources. The expected impact of new models of care on hospital use should not […]
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We are so used to the attacks on the NHS from the Daily Mail that we forget that it can be merciless to private medicine too. A critical article by Lois Rogers for the Mail’s on-line edition on June 12th provoked a defensive response from the Association of Independent Healthcare Organisations (AIHO). Rogers’ attack begins with the story of a man (a Director of a high-end car company) who underwent surgical removal of the prostate (no small procedure) in a private hospital, only to be told years later that the surgery had not been necessary. According to the Mail’s journalist […]
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The NHS has no memory but the labour movement does, although it is sometimes patchy. A conference convened by the Institute of Public Policy Research and the London School of Hygiene and Tropical Medicine on May 9th illustrated how long-standing the issues now being debated around regional devolution of the NHS really are. Discomfort with devolution of powers is hard-wired into the NHS. Commitment to funding the NHS from general taxation inevitably leads to Parliamentary accountability, without the word ‘centralisation’ being used. Likewise, concern at inequities encourages central control to iron out variations in care. Whilst politicians of all parties […]
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Has the budget squeeze in the NHS had an effect on NHS performance, beyond waiting times? In particular, has it reduced the quality of care? The King’s Fund has tried to answer this question with its report ‘Understanding NHS financial pressures’, published on March 14th. The study focused on hip replacement, neonatal care, district nursing and genito-urinary medicine. It concluded that acute services – hip replacement and neonatal care –have been relatively protected so far, whilst community-based services have experienced static or falling budgets, with probably knock-on negative effects on patient care. The number of hip replacements is rising (although […]
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The Sustainability & Transformation Plans are running out of steam, thanks to the Government’s squeeze on NHS finances. An attempt to think about how to develop a better and sustainable care system has turned into a financial rescue plan for hospitals. At the end of March STPs will be “refreshed” but it is hard to have much confidence in the outcome. The NHS may simply default to its standard operating procedures. Anticipating this Don Redding, of the charities’ coalition ‘National Voices’, has argued in a Health Services Journal article about STPs that the current problems of the NHS will not be […]
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STPs are loose coalitions of agencies without statutory powers, so they cannot implement change, only encourage it. With little money left in the Transformation Fund, they have to “work around” their local NHS and social care organisations. At the launch of the King’s Fund report ‘Delivering sustainability and transformation plans: from ambitious proposals to credible plans’ (on 21st February) we heard that “with the right leadership” STPs could stabilise the NHS, that STPs mean that “politicians must be brave” (and not impede changes in the NHS in their constituencies), that NHSE and NHSI need to work as one (because they […]
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The defeat of the junior doctors was ignominious, and made worse by a failed legal challenge to the Secretary of State’s right to impose a contract. As the dispute collapsed, senior members of the medical Royal Colleges, who had tried to walk a fine line between supporting junior doctors and ensuring the health service could function, began to speak(off the record) about ‘Generation Me’ – entitled young people who want lots of money but not to work hard, and feel they should have it all. Some hospital managers who noticed how much more efficient their services were when consultants delivered […]
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Don Berwick, a North American fan of the NHS and critic of the wasteful US healthcare system, urges us to create ‘Era 3’ of modern medicine ( Berwick D Era 3 for Medicine & Health Care JAMA 2016;315(13): 1329-1330). Era 1 was the period of noble, beneficent, self-regulating professionalism that powered the NHS assembled by Labour in 1948. In the compromises needed to launch the new health service, the political class conceded to the professions the authority to judge the quality of their own work. Era 2 began when the variations in the quality of care; the injustices and indignities inflicted […]
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The alleged crisis in GP recruitment is a political red herring. The bigger issue is the deep need for a change to the structure of commissioning, writes Andrew Haldenby, in a recent report from the right wing think tank ‘Reform’. He goes on to argue that access to general practice via new technology remains in a relative Stone Age. Only 7 per cent of people report that they have booked appointments online. The current model of general practice is obsolete, it is true, and the Royal College of GPs knows this even if it is uncertain what to do about […]
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It had to come sooner or later, and it has come sooner. Christopher Smallwood, chair of St. George’s University Hospitals NHS Foundation Trust, writing in the Guardian on Monday February 8th, claimed that the “free at the point of use” mantra has had its day. It is time to allow insurance to play a part in funding the NHS, he said. This is no dodgy dossier from a right-wing think-tank, picked up briefly by the Tory press. It is a serious view from a senior NHS figure, published in a centre-left newspaper and included in a Guardian-sponsored public debate. And […]
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