Rural health care: A rapid review of the impact of rurality on the costs of delivering health care

Nuffield Trust | January 2019 | Rural health care: A rapid review of the impact of rurality on the costs of delivering health care

The Nuffield Trust was commissioned by the National Centre for Rural Health and Care to explore the key issues around the impact of rurality and sparsity on the costs of delivering health care.

nuffield trust
Image source:



The aims of the review were to:

  • outline the policy considerations around accounting for unavoidable costs in providing health care in rural areas
  • review and summarise key evidence on the additional costs of delivering health care in rural areas
  • describe, quantify and critique current NHS allocation formulae in the four UK nations with respect to adjustments for rurality.

Their analysis suggests that while the association between rurality, overstretched services and financial pressure are unclear, NHS trusts with ‘unavoidably small’ sites do appear to underperform: as well as having generally longer waiting times and lengths of stay, they are also in greater financial difficulty.

The report can be downloaded from Nuffield Trust

Rural health care: A rapid review of the impact of rurality on the costs of delivering health care [Press release]

Are patients benefiting from integrated care?

Nuffield Trust | January 2019 | Are patients benefiting from integrated care?

As QualityWatch publishes a scrolling data story investigating whether the drive in recent years to integrate services more closely has resulted in any tangible improvements for patients, Sarah Scobie puts the study in context and explains the findings. They find there is limited evidence that patients are benefiting from better integrated care: only one of the seven indicators has improved, three have deteriorated, and three show either no change or an inconsistent pattern (Source: Nuffield Trust).


Nuffield Trust Are patients benefitting from better integrated care?

See also:

Quality Watch Are patients benefiting from integrated care? 


Snowed under? Understanding the effects of winter on the NHS

Nuffield Trust | December 2018 | Snowed under? Understanding the effects of winter on the NHS

A new explainer from the Nuffield Trust unpacks what winter means for the NHS, in terms of its impact on health, demand for services, and how the NHS responds.winter-snow-nature-60561.jpeg

Key points

  • Even moderately cold weather (an average temperature of 5­–8 degrees celsius) results in increased illness and higher death rates.
  • Flu epidemics have a major impact when they occur, but there is significant variation from year to year in how many people and which groups are affected.
  • Primary care deals with most of the increase in winter-related illness. Small changes in the ability of primary care teams to manage peaks in demand become amplified across the wider care system.
  • The number of A&E attendances actually decreases in winter, but the proportion of people admitted increases.
  • A higher proportion of patients with longer lengths of stay in winter means hospitals have less flexibility to manage demand.
  • Given recent trends, we can expect the pressure on the NHS this winter to be similar to last year.
  • Although A&E waiting times tend to grab the headlines, health systems should consider a broader range of factors when assessing winter pressures, from deaths related to cold temperatures and provision of services in the community through to the way acute medical patients are managed in hospital. (Source: Nuffield Trust)


In safe hands? The need to know more about safety in health care

Nuffield Trust | December 2018 | In safe hands? The need to know more about safety in health care

In the latest blog on the Nuffield Trust blog, Sarah Scobie considers whether safety is being measured and monitored appropriately and what steps could improve it in the long run; long run? Scobie argues for a shift in our understanding.



Scobie reflects on:

  • Measuring safety, rather than harm
  • What data tells us
  • Safety gaps

Read the full blog post from the Nuffield Trust

Safety in health and social care

Nuffield Trust| December 2018 |Safety in health and social care

QualityWatch-the Nuffield Trust and Health Foundation programme providing independent scrutiny into how the quality of health and social care is changing over time-  have  reviewed and updated their indicators looking at how the safety of NHS care has changed over time. Although there are some gaps in the data, due to limited information in areas such as primary care and community settings, they  have been able to identify indicators at a national level across many aspects of safety. While some measures show an improvement, such as the management of venous thromboembolism and hospital cleanliness, other measures, such as the proportion of hip fracture cases that have prompt surgery, have not improved. Please find below a summary of our safety indicators, and click on the links for more content and analysis (Source: Nuffield Trust).

The indicators:

Safety culture 

Are patients told about medication side effects?

Hospital cleanliness 

Healthcare-associated infections

Injuries due to falls 

Venous thromboembolism

Emergency readmissions

Suicide in mental health service users

Social care users and safety 

Improving access and continuity in general practice

Nuffield Trust | November 2018 |Improving access and continuity in general practice

The report describes the Nuffield Trust’s key findings on the impact of improved access upon continuity of care, and provides a series of recommendations for commissioners and policy-makers. 

Improving access and continuity in general practice is based on four research questions:

  • What is the evidence that continuity within general practice benefits patients, or is important to health professionals?
  • Which primary care patients are more likely to want continuity of care, and how likely are they to report receiving it?
  • How might policy initiatives to improve access affect continuity of care, and to what extent is there evidence of this?
  • What factors might best support continuity of care in the context of improved access?
Image source:

The study combined:

  • a rapid literature review
  • interviews with nine providers, one commissioner of services, and site visits to two services that are seeking to combine access and continuity
  • analysis of data from the GP Patient Survey
  • two expert meetings involving clinicians, managers, academics and policy-makers


Download the evidence review 

Download the summary report