• The Nuffield Trust has published its own research into the credibility of the proposals to shift care into the community, the proposals which underlie Simon Stevens' "Five Year Forward View" (2014) and its implementation in the 44 regional "Sustainability and Transformation Plans" (STPs) (2016).

    The Nuffield Trust  "Shifting the balance of care: Great Expectations" was published in March 2017.

    I have selected two key messages from the report:

    ....• Nonetheless, in the context of long-term trends of rising demand, our analysis suggests that the falls in hospital activity projected in many STPs will be extremely difficult to realise. A significant shift in care will require additional supporting facilities in the community, appropriate workforce and strong analytical capacity. These are frequently lacking and rely heavily on additional investment, which is not available.

    .....• While out-of-hospital care may be better for patients, it is not likely to be cheaper for the NHS in the short to medium term – and certainly not within the tight timescales under which the STPs are expected to deliver change. The wider problem remains: more patient-centred, efficient and appropriate models of care require more investment than is likely to be possible given the current funding envelope.

  • Nick Triggle, Health Correspondent - BBC News website 7th February 2017

    Although this article is now four months old, it is still a useful summary of the overall problems besetting the NHS and social care in the UK.

    What it does not address is (1) the impact of wasteful marketisation and (2) the massive reorganisation called "Sustainability and Transformation Plans" which the Conservative government and CEO Simon Stevens are currently promoting.

    The charts are:


    1. We spend more on the NHS than ever before

    2. A bigger proportion of public spending goes on health

    3. Key A&E targets are being missed

    4. The UK's population is ageing

    5. Care for older people costs much more

    6. Increases in NHS spending have slowed

    7. The UK spends a lower proportion on health than other EU countries

    8. Demand for A&E is rising

    9. Fewer older people are getting help with social care

    10. Much more is spent on front-line healthcare than social care

  • http://www.nuffieldtrust.org.uk/media-centre/press-releases/hospital-bed-squeeze-being-miscounted-and-causing-congestion

    11 October 2016 - The Nuffield Trust


    With performance falling below targets and winter approaching, a Nuffield Trust briefing today warns the NHS can no longer find enough bed space to move patients through hospitals quickly and meet key A&E targets – and that its practice of counting patients at midnight means we are missing the true scale of the squeeze.

    Understanding patient flow in hospitals, a briefing for NHS managers, estimates that 5.5% of beds need to be free for cleaning and preparation if patients are to be moved through quickly enough to meet the high-profile commitment to admit or transfer emergency patients within four hours. Yet many hospitals are unable to provide this much of the time, making target breaches inevitable. With a growing number of patients coming and going during the day, counting bed occupancy at midnight means that crunch times are often invisible.

  • Map of threatened A&Es

    The March Route