Reconfiguration of NHS services

Reconfiguration of NHS services (England) | The House of Commons Library

This document summarises recent policy developments and trends, the involvement of the public and local authorities in the reconfiguration process, and the major drivers of change.

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A systems approach to health and care design

A more holistic or ‘joined-up’  systems approach to health and social care provision could help  transform the way these essential services are delivered and address the needs of a changing patient population | Royal College of Physicians

The Royal Academy of Engineering, the Academy of Medical Sciences and the Royal College of Physicians have published Engineering better care: a systems approach to health and care design and continuous improvement.

This report explores how an engineering approach could be applied in health and social care to develop systems that meet the needs of patients, carers and NHS staff.  It presents a framework to support ongoing work in service design and improvement in health and care.  It found that more widespread application of a rigorous systems approach to health and care improvement, has the potential to have a transformative effect on health and care.

Full document: Engineering better care: a systems approach to health and care design and continuous improvement.

 

Transformational change

Leading Large Scale Change: A practical guide | NHS England Sustainable Improvement Team | NHS England Horizons Team

This guide from NHS England has been produced to help all those involved in seeking to achieve transformational change in complex health and care environments. This is a fully revised update of the original 2011 publication, responding to current health and care policy and practice, and introducing new concepts, tools and techniques to help deliver successful large scale change. It is relevant to all those involved in transformational change programmes such as Sustainability and Transformation Partnerships (STPs) and the development of new care models, and has relevance across public services.

The publication includes:

  • Updates on the leading transformational change models
  • The latest thinking from national and global improvement
    experts and change leaders
  • New tools, techniques and tips to help effectively progress
    large scale change programmes
  • Case studies and learning that will help leaders and
    change agents in health and care and across public
    services
  • Signposting to a host of new online resources including
    videos, presentations and digital media links.

Full document: Leading Large Scale Change: A guide to leading large scale change through complex health and social care environments

 

Accountability of partnership working

Scrutiny: the new assurance?  A good governance discussion document. |The Good Governance Institute 

As collaboration and partnership working need to become more streamlined, more strategic and more effective, organisations spending public monies should be constantly redefining their roles and responsibilities, searching for constant improvement. This paper looks at scrutiny across a number of organisations, as all four home nations are seeking better outcomes by the alignment of health, social care and other funders and providers.

Download the publication here

New model of Primary Care provision

New report from the Nuffield Trust evaluates an initiative called the Primary Care Home (PCH) model developed by the National Association of Primary Care (NAPC).

The primary care home model was developed by the National Association of Primary Care as a response to workforce challenges, rising demand and opportunities to shape transformation in local health and care systems across England.

pch

Image source: nuffieldtrust.org.uk

This report from the Nufield Trust suggests that the new models of primary care provision are showing early signs of success but will need more resources and support for these models to work well on a permanent basis.

The evaluation found that participating in the primary care home programme had strengthened inter-professional working between GPs and other health professionals while also stimulating new services and ways of working, tailored to the needs of different patient groups.

It was judged to be too early in the scheme’s development for the Nuffield Trust to quantify impacts on patient outcomes, patient experience or use of wider health services.

Full report: Primary Care Home. Evaluating a new model of primary care.

Related: New primary care model needs resources, say experts | OnMedica

Involving staff with quality improvement initiatives

NHS Employers has published Staff involvement, quality improvement and staff engagement:  the missing links.

This briefing aims to help managers and leaders understand more about how involving staff with quality improvement initiatives can have a significant impact on staff engagement levels.

Involving staff in quality improvement decision-making, planning and delivery has always been a good idea. However, at a time of unprecedented pressures and financial challenges it is an issue of the highest importance.

This new briefing explores the benefits, approaches and working examples of how organisations are involving staff with their quality improvement activities.

Read more about staff engagement initiatives across the NHS here.

Competition policy in five European countries

This working paper explores how policies affecting competition have been implemented and promoted in health systems in five countries: France, Germany, the Netherlands, Norway and Portugal | Health Foundation

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  • In conventional markets, customers are attracted to particular suppliers by a more appealing combination of price and quality. But in health care, patients are usually insulated from costs and may find it difficult to judge quality due to information asymmetries and their infrequent use of services.
  • This means that the question – what do we expect or want of competition? – is not so easily answered in health care settings, and lessons from other sectors might not apply.

Key points:

  • Proximity to the health care provider, rather than quality, remains the key driver of patient choice.
  • There is potential tension between stimulating quality competition and controlling expenditure because restrictions on hospital treatments imply that money does not follow the patient, and hospitals may react by making access more difficult or letting their waiting times increase.
  • Information for assessing proposed hospital mergers requires improvement, particularly information on quality.
  • There is limited scope for further expansion in the use of private providers to treat NHS patients given the current focus on controlling expenditure.
  • The economic rationale for controlling entry of providers into general practice is unclear.
  • Selective contracting for patients with chronic and multiple conditions to reduce fragmentation of care raises concerns for competition and regulation. This is because of the long-term nature of the implied contracts and the restricted pool of potential providers willing to bid for these contracts.

Read the working paper here