NHS standards and performance: is prioritisation the answer?

The Kings Fund June 2017 quarterly monitoring report (QMR) showed that NHS performance on key access targets over the financial year 2016/17 continued to deteriorate. In this new blog James Thompson asks whether a combination of increased funding, incentives and pressure from the centre will be enough to get A&E waiting time targets back on track.

NHS Estates

The Kings Fund has published NHS Estates: Review of the Evidence

This report sets out the findings of an evidence review in relation to estates strategy, commissioned by the Department of Health.  It includes evidence on the approach to developing a strategy, and the different components required for an effective strategy. It also identifies the skills and capability involved in estates strategy development, and provides examples of some of the models for estates development that have been used in the NHS and elsewhere in the public sector (both in the United Kingdom and abroad).

The report can be downloaded here

Mental health and new care models

GPs need to prioritise mental health more, say experts. | Mental health and new models of care | Kings Fund | OnMedica

While some of the vanguard sites developing new care models report promising early results from adopting a whole-person approach, the full opportunities to improve care through integrated approaches to mental health have not yet been realised.
This Kings Fund report draws on recent research with vanguard sites in England, conducted in partnership with the Royal College of Psychiatrists. The report found that where new models of care have been used to remove the barriers between mental health and other parts of the health system, local professionals saw this as being highly valuable in improving care for patients and service users. But there remains much to be done to fully embed mental health into integrated care teams, primary care, urgent and emergency care pathways, and in work on population health.

The main vehicle for rolling out what vanguards are trying to achieve are England’s sustainability and transformation plans (STPs) and there are concerns, said the authors, that some STPs had limited content on mental health.

‘It is vital that STP leaders are encouraged to make mental health a central part of their plans, and that they are able to take heed of the emerging lessons from vanguard sites,’ says the report.

More mental health support is needed in GP surgeries, said the authors. They recommend strengthening mental health capabilities in the primary and community health workforce by improving the confidence, competence and skills of GPs, integrated care teams and others.

Compassionate leadership in health care

Caring to change:  How compassionate leadership can stimulate innovation in health care | Kings Fund

face-985982_1920

This paper looks at compassion as a core cultural value of the NHS and how compassionate leadership results in a working environment that encourages people to find new and improved ways of doing things.  It describes four key elements of a culture for innovative, high-quality and continually improving care and what they mean for patients, staff and the wider organisation: inspiring vision and strategy; positive inclusion and participation; enthusiastic team and cross-boundary working; and support and autonomy for staff to innovate. It also presents case studies of how compassionate leadership has led to innovation. This work was supported by the Health Foundation.

Download the full report here

Related Kings Fund blog: Compassionate leadership – more important than ever in today’s NHS

Understanding NHS financial pressures. How are they affecting patient care?

The Kings Fund has published ‘Understanding NHS financial pressures. How are they affecting patient care?’

Understnading NHS financial pressures

Image source: https://www.kingsfund.org.uk/

Financial pressures on the NHS are severe and show no sign of easing. However, we know relatively little about their impact on patient care.

This study sought to investigate the impact of financial pressures in four very different areas of the health service: genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal services. The research used data analysis and interviews to explore different experiences across the system.

The researchers found that GUM and district nursing services were under particular strain. Both access to services and quality of patient care have been affected in ways that are difficult to detect with currently available metrics.

Within elective hip replacement services, activity has increased in recent years and patients remain happy with the outcome of their operations, but the latest data shows that average waiting times for treatment are starting to rise. Neonatal services appear to have largely maintained quality and access despite a number of longstanding pressures, although there is variation between units.

The findings create a challenge to the direction of travel set out in the NHS five year forward view of strengthening community-based services and focusing on prevention.

Read more here

The impact of NHS financial pressures – a mixed picture

Recent figures reveal a provider deficit of nearly £900 million for the first three quarters of 2016/17 – a clear sign that NHS organisations are struggling in the face of constrained budgets and growing demand | Lillie Wenzel – The King’s Fund Blog

coins-948603_960_720 (2).jpg

As NHS organisations seek to manage current pressures, the number of media stories suggesting that tight health budgets are having a negative impact on patient care is increasing. But is this the whole picture?

For the NHS, the relationship between financial performance and quality of care is complex. Indeed, a recent Public Accounts Committee report recommended that the Department of Health and NHS England undertake work to better understand the association between the two. We know that the actions NHS organisations take when they are under financial pressure can affect patient care in a number of ways. We also know that patient care is affected by many factors besides funding, and that both national data and public attention tend to focus on care delivered within hospitals.

Our research, set out in Understanding NHS financial pressures, aimed to get beneath the top-level data and explore in more detail how patients are being affected by the financial pressures facing the NHS. We looked at four different service areas – genito-urinary medicine (GUM), district nursing, elective hip replacement and neonatal – to try to understand the impact in different parts of the system.

Read the full blog post here

Sicker patients the main reason for A&E winter pressures

Sicker patients with more complex conditions are the main reason for worsening performance in A&E departments, according to The King’s Fund’s latest quarterly monitoring report.

hospital-1636334_1920

Eighty per cent of NHS finance directors who responded to the latest Kings Fund survey identified higher numbers of patients with severe illnesses and complex health needs as a key reason for the pressures on A&E units, while 70 per cent cited delays in discharging patients from hospital. In contrast, only 27 per cent pointed to poor access to GPs and 20 per cent identified shortages of clinical staff as key factors.

The survey also highlights the effort made by the NHS to prepare for increased pressure on services during the winter. More than 70 per cent of the trusts surveyed increased their staff, while 80 per cent of clinical commissioning groups (CCGs) paid for extra resources in primary care. Other common measures included postponing planned treatment, paying private companies to take on NHS work, and paying higher rates to recruit more agency staff.

Read the full report here