Health Management and Policy Alert

Does hospital competition reduce rates of patient harm in the English NHS?

Competition and Markets Authority -
Previous hospital mergers have reduced the number of distinct organisations offering publicly funded and provided care in the NHS, reducing choice and between-hospital competition in some areas. This research tests the impact of variation in concentration on a new quality indicator: the prevalence of patient harm from falls, pressure ulcers, blood clots and urinary tract infections. It finds that hospital mergers in concentrated areas without offsetting clinical benefits could significantly increase rates of patient harm.

• Report
• Competition and Markets Authority - publications

The NHS long term plan

NHS England -

The plan focuses on improving services outside hospitals and moving towards more joined-up, preventative and personalised care for patients, and the ambition to establish integrated care systems in every part of the country by 2021. It includes measures to: improve out-of-hospital care, supporting primary medical and community health services; ensure all children get the best start in life by continuing to improve maternity safety; support older people through more personalised care and stronger community and primary care services; and make digital health services a mainstream part of the NHS. In addition, this ten-year plan includes measures to prevent 150,000 heart attacks, strokes and dementia cases, and better access to mental health services for adults and children.

• Plan
• Press release

The NHS long term plan

NHS England -

The plan focuses on improving services outside hospitals and moving towards more joined-up, preventative and personalised care for patients, and the ambition to establish integrated care systems in every part of the country by 2021. It includes measures to: improve out-of-hospital care, supporting primary medical and community health services; ensure all children get the best start in life by continuing to improve maternity safety; support older people through more personalised care and stronger community and primary care services; and make digital health services a mainstream part of the NHS. In addition, this ten-year plan includes measures to prevent 150,000 heart attacks, strokes and dementia cases, and better access to mental health services for adults and children.

• Plan
• Press release

Letting local systems lead: how the long-term plan could deliver a more sustainable NHS

NHS Confederation -
According to this report, the NHS long-term plan must help bring about a “breakthrough” in the development of local health and care systems by allowing them greater freedom and minimising central control. The report calls for a focus on tackling the barriers to local system working as NHS England prepares to publish its blueprint for the coming decade.

• Report
• NHS Confederation - news

Clinical engagement and collaboration: Newcastle Gateshead CCG

NHS Clinical Commissioners - 

The Core Cities Network is a peer-led network representing clinical commissioning groups from the eight core cities in England outside London – Nottingham, Leeds, Sheffield, Bristol, Newcastle, Birmingham, Liverpool and Manchester. This case study explores the value of clinical engagement and collaboration, as well as the challenges and benefits from working across different geographies.

• Case study
• Core Cities Network

How should health policy respond to the growing challenge of multimorbidity?

University of Bristol - 

There is growing awareness internationally of the increasing number of people living with multiple long-term health conditions, known as multimorbidity. Health services, including the NHS, need to adapt to address this challenge. This policy report discusses the issue of multimorbidity, and offers a summary of recommendations.

• Report
• Press release

Closing five emergency departments not linked with increased hospital admissions, though ambulance call-outs increased

National Institute for Health Research - NIHR Signal -

Closure of five small emergency departments in England was not associated with change in the number of hospital admissions, urgent care attendances or deaths among the local populations. However, ambulance call-outs increased by 14 per cent relative to comparison areas, with a four-minute increase in the time to reach a hospital with an emergency department. This NIHR-funded study is the first to assess the impact of downgrading or closing emergency departments.

• NIHR Signal

Changing the system: major trauma patients and their outcomes in the NHS (England) 2008–17

The Lancet - 

This independent report, commissioned by NHS England and published in The Lancet open-access journal EClinicalMedicine, found that the creation of major traumas centres led to the survival of more than 1,600 patients who have suffered some of the most severe and complicated injuries thanks to top teams of surgeons, doctors and clinical staff. Patients also spent fewer days in hospital and had improved quality of life after receiving critical care.

• Report
• Press release

Clinical pharmacists in general practice: pilot scheme evaluation

University of Nottingham - 

This evaluation report showed that clinical pharmacists significantly increase patient appointment capacity and reduce pressure on GPs. More than 490 clinical pharmacists were placed in over 650 practices across England in the pilot project which supports the aim of having over 2,000 clinical pharmacists working in general practice by 2020/21 – a ratio of one per 30,000 patients. The research team investigated the work of the newly created clinical pharmacist roles from the perspectives of the pharmacists, those working immediately with them in their roles, professional stakeholders and patients.

• Report
• Press release

A picture of health: the NHS at 70 and its future

The Fabian Society - 

This report, edited by the Shadow Health Secretary Jonathan Ashworth MP, explores a comprehensive agenda for the future of the NHS looking at how it is funded, organised and reformed. It brings together analysis and policy recommendations from twelve leading experts on the NHS from both left-wing and non-party perspectives. These authors include Luciana Berger MP, Paul Williams MP, Lord Kerslake, Sara Gorton (head of health at UNISON), Tara Donnelly (chief executive at the Health Innovation Network), and Andrew Harrop (Fabian Society).

• Report
• Press release