How does the NHS in England work?

The Kings Fund has produced a new animation, ‘How does the NHS in England work? An alternative guide’

Related Kings Fund blog: How does the NHS work? A never-ending story

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Accountable care

Accountable care: policy fad or step forward on the journey towards integrated care? | Nicola Walsh |The Kings Fund

Accountable care is under discussion almost everywhere in the NHS. Groups of NHS providers (sometimes with the local commissioner) are exploring how they can work more closely together to take on the responsibility for the health and care of a given population within a given budget. Currently, we are seeing emerging accountable care arrangements adopting various forms according to local needs and preferences: in some areas the focus is on creating a single organisation; in others, organisations are keen to use the words ‘system’ or ‘partnership’ – to reinforce the notion of working together.

In this Kings Fund blog, Nicola Walsh looks in more detail at Accountable Care Systems and partnerships.

Quality improvement

Making the case for quality improvement: lessons for NHS boards and leaders | The King’s Fund | The Health Foundation

This briefing outlines the following ten lessons for NHS leaders which provide a starting point for those seeking to embed quality improvement in their work:

  • Make quality improvement a leadership priority for boards.
  • Share responsibility for quality improvement with leaders at all levels.
  • Don’t look for magic bullets or quick fixes.
  • Develop the skills and capabilities for improvement.
  • Have a consistent and coherent approach to quality improvement.
  • Use data effectively.
  • Focus on relationships and culture.
  • Enable and support frontline staff to engage in quality improvement.
  • Involve patients, service users and carers.
  • Work as a system.

The briefing makes the case for quality improvement to be at the heart of local plans for redesigning NHS services.

Full report available here

Number of NHS beds more than halved over the past 30 years

The number of NHS beds has fallen by half in 30 years, and plans for further cutbacks are “unrealistic” | The Kings Fund

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A study from The Kings Fund has found that bed numbers – including general and acute, mental illness, learning disability, maternity and day-only beds –  have dropped from 299,000 to 142,000 since 1987.  Hospitals in England now have the least number of beds for their population compared with any other country in the European Union, with just 2.3 per 1,000 people.

The report explains that this decline is in part due to factors such as an increase in care being delivered outside hospitals. It also highlights the impact of medical innovation including an increase in day-case surgery, which has also had an impact by reducing the time that many patients spend in hospital.

The report however warns that there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe. The authors state that in this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.

Full report: NHS hospital bed numbers: past, present, future

NHS funding and privatisation: the facts

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A lecture and article by the scientist Professor Stephen Hawking outlining his views on the NHS have prompted a lively debate about a number of issues.

Here the Kings Fund looks at the facts about two of these: whether the NHS is being privatised and if it has been given the funding it needs:

Is the NHS being privatised?
The involvement of the private sector in the NHS is a hotly contested topic. Private companies have always played a role in the NHS, but critics claim that their increasing involvement is evidence of growing privatisation of care and is undermining the service’s core values.

Does the NHS need more money?
In recent years, spending on the NHS has been protected while other budgets, such as those for local government services and policing, have been subject to significant cuts. Despite this, health services are facing unprecedented financial and operational pressures, with many NHS organisations in deficit and key performance standards being missed.

Quality improvement in mental health

Quality improvement in mental health | The King’s Fund

This report explores the potential opportunities arising from the application of quality improvement approaches in the mental health sector and identifies relevant learning from organisations that have already adopted these approaches.

The authors were specifically interested in understanding how and why some mental health organisations have embraced quality improvement strategies and what has enabled them to do so. It explores what changes are needed from senior leaders to cultivate a quality improvement ethos within their organisation.    

Key findings

  • Embracing quality improvement requires a change in the traditional approach to leadership at all levels of an organisation, so that those closest to problems (staff and patients) can devise the best solutions and implement them.
  • Doing quality improvement at scale requires an appropriate organisational infrastructure, both to support frontline teams and to ensure that learning spreads and is taken up across the organisation.
  • Tools and approaches used in the acute hospital sector can be adapted for use in mental health care, including in community settings.
  • Success is most likely when there is fidelity to the chosen improvement method, and a sustained commitment over time.
  • The strong emphasis on co-production and service user involvement in mental health can be harnessed as a powerful asset in quality improvement work.

Download the full report: Quality improvement in mental health

Big cuts planned to public health budgets

Plans to cut public health budgets by £85m this year ‘self-defeating’ | story via Kings Fund

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Public health services such as sexual health clinics and services reducing harm from smoking, alcohol and drugs are to be cut by £85m this year by local authorities, despite having their budgets severely reduced in recent times, new research has found.

In findings released by the King’s Fund which analysed Department of Communities and Local Government data, it was revealed that councils in England were planning to spend £3.4bn on public health services in 2017-18.

However, on a like-for-like basis excluding the impact of changes to how budgets are calculated over different years, councils will only spend £2.52bn on public health in 2017-18 compared to £2.60bn last year.

Once inflation is factored in, the King’s Fund experts also discovered that public health spending is more than 5% less in 2017-18 than it was four years ago, in 2013-14.

Full story at The Kings Fund

Related: Kings Fund blog: Chickens coming home to roost: local government public health budgets for 2017/18