Welcome to the Civitas Health Unit
The health unit was set up to facilitate informed and impartial debate among key stakeholders, patients, and the grassroots of the medical profession, in order to help build consensus on the future of health care in the UK.
Our research aims to bring fresh thinking to problems facing the NHS through careful analysis and a consideration of what can be learnt from other health systems. From this, we endeavour to generate evidence-based ideas that are committed to high-quality, universal, safe and integrated health care.
We also helped to set up Lead-In, formerly known as Young Civitas for Medics. Now with over 1,000 members, Lead-In aims to engage medical students in debates about the future of health care and develop critical thinking skills.
REPORT: NHS Contribute Extra: A return to the NHS's core values
NHS patients should be given the opportunity to take their personal treatment budgets to any suitable healthcare provider in return for a modest additional monthly payment, this new Civitas report argues. The reform has the potential to raise billions of pounds a year to help plug the health service's widening budget deficit and give patients more flexibility and control over where they are treated.
BRIEFING: Weekend Mortality on the Continent: the cases of Germany and France
For a number of years we have been aware of higher mortality rates during weekend hospital admissions in the UK. Edmund Stubbs investigates whether this ‘weekend effect’ exists in France and Germany, and how healthcare system differences in each country could influence this phenomenon.
BRIEFING: A Season of Major Incidents: What is really causing the A&E crisis this winter?
What has caused this year’s winter crisis in A&E? Edmund Stubbs identifies 11 factors potentially contributing to emergency departments’ current poor performance. He also explores the differences between England and Wales, and whether these can be attributed to differences in leadership.
BRIEFING: National auditing beats Parliamentary accounting
Professor Stone examines the National Audit Office's latest report on NHS funding and explains why the NAO and Public Accounts Committee should question fundamentally the formula used to calculate CCG target allocations.
BRIEFING: Breaking the SMR grip on the NHS public funding formula
In his continuing criticism of NHS England's mechanism for allocating funding, Professor Stone illustrates an area where Scottish practice is preferable to English.
BRIEFING: Healthcare Systems: Ireland & 'Universal Health Insurance' – an emerging model for the UK?
Another addition to the Civitas ‘Healthcare Systems’ series, exploring Irish healthcare, similarities and differences with the UK and Ireland's emerging Dutch-inspired Universal Health Insurance (UHI) reforms as a possible case study.
BRIEFING: Explicating ‘wrong’ or questionable signs in England’s NHS funding formulas: correcting wrong explanations
Professor Stone's thorough demolition of the new version of the formula for distributing public money to Clinical Commissioning Groups.
BRIEFING: Healthcare Systems: Sweden & localism – an example for the UK?
A new addition to the Civitas ‘Healthcare Systems’ series, exploring the Swedish system, democratic localism and recent market reforms.
POLICY IDEAS: A National Health Service for patients
This paper calls for the NHS to tackle its current “crisis of accountability” by decentralising commissioning and letting non-profit mutuals, trade unions, cooperatives and friendly societies set up Patient-led Commissioning Groups (PCGs) alongside the current GP-run Clinical Commissioning Groups (CCGs), empowering patients to take control of commissioning for themselves.
BRIEFING: After Francis: Standards & Care Quality in the NHS
This report reviews the current landscape of British healthcare in the wake of the Mid Staffordshire scandal and the Francis report, assesses how the NHS is performing relative to other nations and examines some of the problems and reform options currently being discussed.
BRIEFING: One small step for the NHS, but one giant leap for its principles?
This paper documents how the British health service has moved away from the principle of comprehensive coverage during the past 30 years, as very minor initial changes in specific policy areas have led eventually to major changes towards private funding. It identifies another seemingly minor decision in 2013 that may lead to an even more dramatic shift away from comprehensive care, one that is unlikely to be offset by private coverage.
COMMENT: Why the health service works for patients in France
A short comment piece by a British business leader and former NHS staff member now living in France, observing differences between British and French health provision.
BRIEFING: The NHS: The Envy of the World?
A brief analysis of a recent ICM poll Civitas commissioned exploring public attitudes towards the NHS and European-style health care reforms. This data shows that while there is pride in the NHS, its meaning should be carefully interpreted, as there is much more public support for radical reform than often meets the eye.
BRIEFING: Plain Explanation or Special Pleading?
An update on UCL statistics Professor Mervyn Stone's work on the issues with current NHS funding allocations. Following a December decision by the NHS Commissioning Board (NHS CB) to reject the previously proposed Person-Based Resource Allocation (PBRA) formula, Professor Stone outlines how even the replacement formula presented to the board has substantial logical flaws and why a "clean sweep" approach to NHS funding allocations is overdue.
BRIEFING: Updated Health Systems briefings
The latest US, German, Dutch, French, Swiss and Canadian health system briefings are now available. This series of online briefings looks at the structure and performance of other health systems and ask whether or not they offer better alternatives to the current NHS, or possible solutions to some of its biggest problems.
BRIEFING: PFI - Still the Only Game in Town?
The Private Finance Initiative (PFI) and the role it has played in NHS infrastructure procurement has long been controversial, with critics arguing it is inefficient and excessively costly while defenders praise it as the best and the only way to procure new NHS infrastructure - the 'only game in town'. With the recent announcement of the 'PF2' reforms by Chancellor George Osborne, this debate has now taken on a new dimension. The aim of this report is to explore whether PFI has been a worthwhile project and what potential alternatives are available.
PUBLICATION: Rejecting an empirical `person-based' formula for funding CCGs in favour of the farming analogue of one-year-ahead extrapolation
In November 2011, eleven health academics published an article revealing the Advisory Committee on Resource Allocation's (ACRA) new 'person-based' funding formula for Clinical Commissioning Groups (CCGs), which are due to take over commissioning in April 2013. Emeritus Professor of Statistical Science at UCL Mervyn Stone has written an article challenging this approach, arguing that we should instead base allocations on a model that extrapolates from historical costs.
BRIEFING: Rationing in the NHS in the Current Fiscal Climate
The National Health Service is currently facing its toughest budgetary challenge since the 1950s, as NHS spending has been frozen in real terms and the NHS is currently tasked with making efficiency savings worth £4 billion every year towards a total saving of £20 billion by 2015. The service also faces additional pressures from demographic change and the current NHS reforms. Concerns therefore exist that increased rationing of care within the NHS may be a risk at the current time. This report explores the evidence that is available relating to rationing in the NHS, to see how much we can ascertain about the current situation within the service.