new models of care

  • Nuffield Trust - "Shifting the balance of care" - March 2017

    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.

  • STPs must “encourage” long term NHS “partnerships” with the private sector

    Calderdale and Kirklees 999 Call for the NHS - article of 10th November 2016, updated on 9th March 2017 for the Budget announcements.

     

    Far from the Sustainability and Transformation Plans marking the government’s shift away from NHS marketisation and privatisation – as some are mistakenly claiming – the opposite is true!

    Since the Autumn 2015 Comprehensive Spending Review that created the Sustainability and Transformation Fund, both the government and its quango NHS England have explicitly linkedthe Sustainability and Transformation Plans to the requirement to “encourage” increased private sector involvement in the NHS.

    Update 9 March 2017

    Behind the derisory £325m STP funding in Hammond’s Spring Budget (for a few “most advanced” STPs)  is the plan for 50% of STP funding to be sourced from private companies via Local Economic Partnerships by 2020 – please see section below: “Strategic partnerships with the NHS and the 39 Local Economic Partnerships”

    Some key aspects of STPs’ mandatory “encouragement” of long term NHS “partnerships” with the private sector include

    • Strategic partnerships with the NHS and the 39 Local Economic Partnerships.
    • The abandonment of  “old-style contracting” and the  imposition of private company-friendly contracting.
    • Embedding digital technology in STPs.
    • Public meeting on Tuesday 29th November, 7pm, at Town Hall: H&F rejects NHS "STP" plans to downgrade Charing Cross and Ealing

      Please come to a public meeting at 7pm at Hammersmith Town Hall on Tuesday 29th November to hear and discuss the response of H&F Council to the latest proposals for cuts in health services in NW London called the "Sustainability and Transformation Plan" or STP.

      The plan involves a complete upheaval of every service, from community care to mental health services to GPs to A&E departments to acute beds in the major hospitals, in NW London. The central aim of the plan is, we are told, to save money: a staggering £1.3 billion over the period to April 2021.

      Hammersmith and Fulham Council strongly opposes the STP and has voiced its opposition to the NHS bodies concerned.

    • Preventing hospital admission: we need evidence based policy rather than “policy based evidence”

      The following is a personal view published on 23rd September in the BMJ on-line.

       

      1. David Oliver, visiting professor of medicine for older people, School of Health Sciences, City University, London EC1V OHB; former national clinical director for older people at the Department of Health
      1. This email address is being protected from spambots. You need JavaScript enabled to view it.

      Politicians push for evidence that supports whatever initiative they back, but formal evaluation often shows such initiatives to have failed, writes former older people czar David Oliver