Our research seeks to track and analyse the NHS reform agenda, and look at whether we can learn from health systems in other countries, to help build consensus on the best way to provide patient-centred, high quality health care for all:
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.
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.
BRIEFING: Commissioning London's HIV Services
The number of people living with HIV in the UK is estimated to be 86,500, representing a threefold increase over the past decade. Over half of all cases are in London. This report focuses on the commissioning of HIV services in London, documenting the findings of semi-structured interviews conducted with key stakeholders in late 2010. It carries particular relevance given the intention of government to transfer commissioning responsibility from Primary Care Trusts to clinical commissioning groups.
BRIEFING: Risk, Equity and Excellence: A commentary on the NHS White Paper
Gordon Brown's former head of public service transformation discusses the risks associated with the Government's proposed overhaul of commissioning in the NHS White Paper.
BRIEFING: A risky business: the White Paper and the NHS
An in-depth analysis questions the proposed abolition of all Primary Care Trusts by 2013, in favour of GP 'consortia'. A more incremental approach is advocated, permitting reform on a 'human' rather than 'utopian' scale.
BRIEFING: NHS White Paper proposals for GP commissioning: does size matter?
It is likely that GP consortia will cover smaller populations than existing PCTs. Analysis of international trends in the size of commissioning organisations and of past performance of PCTs shows there is little if any theoretical or empirical evidence to suggest a move to smaller commissioning organisations will lead to better commissioning or patient care.
BRIEFING: NHS White Paper: Transferring commissioning responsibility from PCTs to GPs
The financial risk posed by the government's plans to transfer commissioning responsibility from PCTs to GPs is substantial and puts the £ 20bn efficiency savings the NHS is required to make in jeopardy. The last restructuring of commissioning, the merging of PCTs in 2006, caused an absolute drop in performance of at least a year. It took three years for the performance of those that were merged to catch up with those that were not.
BRIEFING: Pre-election briefing on health care and the NHS
A glance at the current state of the NHS; Labour's achievements over the past decade; and what the political parties are proposing for the NHS.
BRIEFING: Formulas at war over two sorts of inequality in health funding
This online briefing looks at the funding formula for primary care trusts (PCTs) - geographic entities that are charged with commissioning (buying) health care in the NHS - and the its weighting for health inequalities, in particular. It argues that the formula is based on 'unscientific formula mongering' and has resulted in a number of PCTs losing out on valuable resources to the tune of millions of pounds.
BRIEFING: BMA campaign to shut out independent sector from NHS is misguided and foolhardy
The BMA have extended their 'Look After Our NHS' campaign, to stop commercially run firms providing NHS care and end the market in the NHS, to patients. However, their campaign is too often based on cherry-picked evidence and appears out of touch with public opinion.
BRIEFING: President Obama should look to Europe, not the NHS
The NHS has been caught up in a media storm around the US health care debate. This briefing calls for a bit more realism, a bit less propaganda. The NHS is neither 'evil' nor the 'envy of the world'. Evidence suggests European health systems perform better than both the NHS and the US; and that President Obama would do well to look across the channel to find better models for providing universal health insurance.
BRIEFING: Why are we waiting? An analysis of waiting times in the NHS
The government have vested much political capital in the 18-week referral to treatment target, but is it really achievable and at what cost? A less distorting approach would be to remove the target and use the framework, already in place, for choice and competition to create a more self-sustaining means of improvement.
BRIEFING: Just how well are we? A glance at avoidable mortality from cancer and circulatory disease in England & Wales
Real improvements have been made, and performance has compared quite favourably with European countries of comparable development, but there are two particular causes for concern: a) the rate of improvement in avoidable cancer mortality has fallen since 1999, at odds with trends since 1979; b) avoidable mortality from circulatory disease remains very high.
BRIEFING: Innovation needs competition
The recommendation of the interim report of Lord Darzi's Next Stage Review, that a Health Innovation Council be set up with a budget of with a budget of #100m 'to help the NHS develop and deploy hi-tech health care such as medical devices and diagnostics' is unlikely to produce tangible benefits until the NHS embraces competition and genuinely empowers patients.
Refusing Treatment: the NHS and market-based reform
Civitas publishes the findings of a year-long study into the effectiveness of the market in the NHS: whether and why it has driven the performance of providers as was intended; and what should be done to make it work better going forwards.
The impact of the NHS market: An overview of the literature
The NHS has operated on the basis of a market since 2002, with a split between purchasers and providers of health care. In the first comprehensive review of the evidence thus far, the authors show market forces have contributed to: improved access for patients; reduced waiting times and increased efficiency; and improved financial management in providers. However, benefits are not widespread. The NHS appears to be in the unfortunate position of taking on the extra costs of competition without realising the benefits.
Markets in health care: the theory behind the policy
In its current state, the NHS functions on the basis of what has been variously called a quasi, mimic or internal market, where providers - NHS, voluntary and private - are theoretically competing and placed on an even footing. With debate around this principle intensifying, this paper revisits the anticipated benefits of the use of market mechanisms; asks on what theory they rest; and where the NHS currently stands.
Putting Patients Last: How the NHS keeps the ten commandments of business failure
In recent years, NHS reform in England has focused on stimulating competition between providers and increasing choice for patients. Many NHS organisations are now as much businesses as they are public bodies; if they fail to design services around patients and meet their needs, they should start to lose custom as well as incurring the wrath of government. But just how good are they at satisfying their 'customers' - the patients? We use a framework developed by Donald R. Keough, former president and CEO of the Coca-Cola Company, to assess this.
Failing to Figure: Whitehall's costly neglect of statistical reasoning
As the size and scope of government grows, so do the resources allocated to public services. But how do we know that allocations are fair or reasonable? In "Failing to Figure" Mervyn Stone examines the process, including the allocation of funds to Primary Care Trusts, and finds it lacking in transparency, and even common sense.
Checking-Up on Doctors: A Review of the Quality and Outcomes Framework for General Practitioners
The Quality and Outcomes Framework (QOF) links up to a third of general practice income to achievement against a series of quality indicators. While it has delivered benefits in the treatment of conditions included, the net benefit is unclear. There is evidence that the financial incentive is diverting attention away from other conditions and harming the relationship between GPs and patients.
Why the NHS is the sick man of Europe
With political interference in the NHS showing no sign of abating, there is a case for considering more radical options than those under review by Lord Darzi: to look to Europe for less centralised ways of providing universal and comprehensive health care. The recent reforms in the Netherlands provide a particularly interesting case.
Quite like heaven? Options for the NHS in a consumer age
Described in a foreword by the former President of the Royal College of Surgeons of England, Bernard Ribeiro, as 'an excellent analysis', Seddon argues it is out respect for the very founding principles of the NHS - universal and comprehensive care - that it must embrace its consumers and open up to real choice and competition to turn it once more into a source of pride.
BRIEFING: Health policy consensus?
The Health Policy Consensus Group came together in 2003 to explore whether or not people drawn from across the political spectrum could agree about the best way to reform the NHS. Comprising senior NHS consultants as well as prominent Labour party members, it set out to preserve the access for rich and poor alike that we all support, whilst increasing consumer choice and personal responsibility for health care expenditure:
Group members: Professor Nick Bosanquet, Anthony Browne, Dr. Adrian Bull, Geraint Day, Lord Meghnad Desai, Helen Disney, Dr. David G. Green, Ben Irvine, Ruth Lea, Dr. Christoph Lees, Andrew Neil, Paul Ormerod, Stephen Pollard, Professor Stephen Smith and Matthew Young.
REPORT: England vs. Scotland: Does more money mean better health?
REPORT: They've had a good innings: Can the NHS cope with an ageing population?
REPORT: Regulating doctors
REPORT: Why ration health care?
REPORT: Stakeholder health insurance
BRIEFING: Has NICE eliminated the 'postcode lottery' in the NHS?
REPORT: Healthcare in the balance: Reassessing the roles of European governments and individuals in health care
REPORT: International medical outcomes - how does the UK compare?
UK's major NHS reforms a 'distraction'
Yes, the NHS needs reform but not if it's going to lead to more patients on trolleys in hospital corridors
Competition is good for the NHS
Andrew Lansley's health reforms won't cure the NHS
Patients benefit from broadening boundaries of NHS care
Let that be, minister, it can heal the NHS
We CAN cut costs in the NHS and it will help save lives
How to get the NHS back on its feet
Will a market deliver quality and efficiency in health care better than central planning ever could? Yes
The market can help the NHS
Competition: The Key to Good Health Care
Obama's plans fuel need for a dose of realism in healthcare debate
Our burdened NHS needs to back its people and start putting patients first
Unintended consequences: what of quality outside the QOF?
'If you remove responsibility you remove the job' - Questioning the official optimism around the QOF in general practice
Have targets done more harm than good in the English NHS? Yes
Reform at the mercy of government
Rejuvenate or retire? Views of the NHS at 60
The NHS was a glorious idea but it needs urgent treatment
Should patients be able to pay top-up fees to receive the treatment they want? Yes
The NHS at 60: Time for a Rethink
We still haven't started the real NHS debate