Achieving a digital NHS: Lessons for national policy from the acute sector

Nuffield Trust | June 2019 | Achieving a digital NHS: Lessons for national policy from the acute sector

With the creation of NHSX, which will unite digital leaders from NHS England, NHS Improvement, and the Department of Health and Social Care to lead on setting standards for technology use, championing and developing digital training and ensuring NHS systems can talk to each other across the health and care system, the Nuffield Trust wanted to know:

  • How national policy impacted on a trust’s approach to digitisation
  • How national policy was helping and hindering digital progress
  • What national policy could do differently to better support digitisation on the ground
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To this end the Nuffield Trust spoke to 72 senior digital leaders in national organisations and NHS trusts as well as frontline health care professionals. Now the Nuffield Trust have published Achieving a digital NHS, which is based on discussion with 72 senior digital leaders in national organisations and NHS trusts as well as frontline health care professional national policy for digitisation, is working from the perspective of acute trusts. This  report seeks to understand how national policy for digitisation is working from the perspective of acute trusts (Source: Nuffield Trust).

Achieving a digital NHS: Lessons for a national policy from the acute sector 

Improving access out of hours: Evaluation of extended-hours primary care access hubs

Nuffield Trust | May 2019 | Improving access out of hours: Evaluation of extended-hours primary care access hubs

The Nuffield Trust was commissioned by Barking, Havering and Redbridge CCGs to evaluate the impact of access programmes in these boroughs.

The schemes aimed to improve the quality of primary care services and to improve patients’ experience and outcomes over a two-year period.


The schemes involved:

  • improving public access to primary care by providing additional capacity outside of core hours
  • the development of a new integrated care hub for the management of people with complex care needs.

Key findings:

  • Most of the patients we interviewed told us that they had chosen to attend the hubs because they found it difficult to attend in-hours primary care services. Others said that they had wanted a speedy clinical assessment for themselves or their children.
  • Patients particularly liked the appointment-based system at the hubs and this was what they highlighted when distinguishing between the hubs and other services such as walk-in centres and A&E departments.
  • Since the hubs opened, there has been an increase in the use of A&E services across the boroughs. However, during our research the size of this increase appeared to be associated with hub attendance in that it was significantly lower in areas where hub attendance was highest by approximately 4.5%. This suggests that the presence of the hubs may have been diverting some people who would otherwise choose to attend A&E, or who may have been sent to A&E by NHS 111, away from this service.
  • However, from a commissioning perspective, such reductions in A&E attendance would not be enough to offset the local cost of providing the hub service.
  • During the study, a call centre had been introduced to improve the appointment booking process. By 2016, between 80% and 90% of patients attending the hubs were recorded as self-referrals, presumably because they had used the call centre. The number of referrals from NHS 111 had remained more stable and generally not increased as new hubs opened.
  • The hubs had adapted to lower demand on Sundays by reducing opening hours and staffing, thus ensuring that Sunday usage rates were comparable to usage rates on other days of the week.
  • Some staff working at the hubs raised concerns about their lack of access to patients’ medical records and their inability to refer patients on for further treatment. Both these areas require effective systems to be in place to avoid the potential of increased clinical risk.
  • Survey responses from staff working at the hubs revealed a largely positive attitude towards working at the hubs, with 59% of staff saying that working at the hubs was better than their other or previous work.
  • It is possible that the hub scheme may have had an effect on the locum market in the area: some staff not working at the hubs suggested that higher locum rates being paid to hub staff might reduce the availability of locums for in-hours work.

Full details from the Nuffield Trust

What can the NHS learn from learning health systems?

Nuffield Trust | May 2019 | What can the NHS learn from learning health systems?

The Nuffield Trust has produced a briefing: What can the NHS learn from learning health systems? 

This briefing identifies opportunities for local organisations and systems to make better use of health data, and recommends ways that national policy could promote the collaboration and greater use of analytics which underpin the LHS concept.  The Nuffield Trust  focuses on lessons for the NHS – but many of the same actions could be taken across the wider health and care system.

Full details available from Nuffield Trust 

The gender pay gap in the English NHS: Analysis of some of the underlying causes

Nuffield Trust | May 2019 | The gender pay gap in the English NHS: Analysis of some of the underlying causes

This briefing from the Nuffield Trus looks at differences in basic pay between men and women employed by the NHS in England, based on data from the NHS electronic staff record for one month. As well as drawing on previous analyses to describe the extent of overall pay differences by staff group, pay band, age and ethnicity, it also identifies factors that drive those differences.

Download the briefing from the Nuffield Trust

(Quality Watch) Care for people with serious illnesses

Nuffield Trust | April 2019 | Care for people with serious illnesses

Care for people with serious illnesses includes a summary of Nuffield Trust’s indicators relating to conditions that cause very high levels of mortality

People with these non-communicable diseases should be cared for according to National Institute for Health and Care Excellence (NICE) clinical guidelines and the standards set out in the NHS Constitution. Following these guidelines will help to ensure that patients receive high-quality care that will enable their conditions to be managed in the best possible way.

The Nuffield Trust used trend data from national clinical audits to look at changes in the quality of care for patients with heart attack, stroke, diabetes and COPD. They also updated our cancer waiting times indicators using data from NHS England.

Further details from Nuffield Trust 

How to address the challenge of multimorbidity?

Nuffield Trust | April 2019 | How to address the challenge of multimorbidity?

A quarter of UK adults are living with two or more long-term health problems (multimorbidity), more than 14 million people in England alone, in a new Nuffield Trust blog post, Charlotte Paddison argues for two key changes in how multimorbidity is tackled. She identifies that change is needed in two areas: 

  • Shift in professional practice
  • Look beyond health services

Full blog post at Nuffield Trust 

See also BMJ for earlier version of post