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The Civitas 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.


Supplying the Demand for Doctors

Supplying the Demand for Doctors: The need to end the rationing of medical training places

Edmund Stubbs, June 2016

The NHS is under strain like never before and its woes are rarely out of the headlines for long. Alongside the host of other issues that the service must confront, like a funding blackhole, it also faces severe recruitment problems. Vacancy levels for permanent positions are high, especially in unfavourable specialties such as A&E and in remote parts of the country. This has… [Full Details]

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The Health of the Nation

The Health of the Nation: Averting the demise of universal healthcare

Edmund Stubbs (ed.), April 2016

Each day seems to bring fresh warnings of the pressures bearing down on the NHS. As resources fail to keep track of demand, the principle of universal healthcare is under threat as never before. Excessive waiting times, the rationing of new drugs, ambulances queuing up outside A&E, staff shortages, the list goes on. What has brought the NHS to the precarious position it… [Full Details]

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Supplying the Demand for Nurses

Supplying the Demand for Nurses: The need to end the rationing of nurse training places

Edmund Stubbs, November 2015

Every year, substantial numbers of nurses are recruited from overseas despite nursing courses in the UK being vastly over-subscribed. This has led to a situation where many, well qualified young people in this country are denied the opportunity to become nurses. This yearly limit on nurse education places also puts the NHS in a weak position for hiring and retaining staff as nurses, knowing… [Full Details]

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Training our NHS Health Workers

Training our NHS Health Workers: Should the UK train more of its staff?

Edmund Stubbs, April 2015

Our country's health system is highly reliant on overseas health workers who often stay less than a year, as well as agency staff who work on a temporary basis at extremely inflated costs. Many posts in unfavourable specialities such as emergency medicine are currently vacant and there is a severe and growing GP recruitment crisis. In this report, Edmund Stubbs suggests that these job… [Full Details]

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NHS Contribute Extra

NHS Contribute Extra: A return to the NHS's core values

Christoph Lees & Edmund Stubbs, February 2015

It is hard to exaggerate the need for increased funding for the NHS. The health service is threatened by a funding gap which could be as large as £30 billion per year by 2020. Even if current yearly efficiency gains were doubled by 2020, it could still be looking at an annual funding gap of £16 billion. Further savings due to efficiency improvement seem optimistic… [Full Details]

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Refusing Treatment

Refusing Treatment: the NHS and market-based reform

Laura Brereton and James Gubb, October 2010

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. Based on in-depth interviews with executives at NHS (foundation) trusts, PCTs, practice-based commissioners and private sector providers across three health… [Full Details]

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The impact of the NHS market

The impact of the NHS market: An overview of the literature

Laura Brereton and Vilashiny Vasoodaven, March 2010

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… [Full Details]

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Putting Patients Last

Putting Patients Last: How the NHS keeps the ten commandments of business failure

James Gubb, Oliver Meller-Herbert, December 2009

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… [Full Details]

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Markets in health care

Markets in health care: the theory behind the policy

James Gubb, Oliver Meller-Herbert, December 2009

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… [Full Details]

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Failing to Figure

Failing to Figure: Whitehall's costly neglect of statistical reasoning

June 2009

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… [Full Details]

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Checking-Up on Doctors

Checking-Up on Doctors: A Review of the Quality and Outcomes Framework for General Practitioners

James Gubb and Grace Li, November 2008

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… [Full Details]

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Why the NHS is the sick man of Europe

Why the NHS is the sick man of Europe

James Gubb, March 2008

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… [Full Details]

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Quite like heaven?

Quite like heaven?: Options for the NHS in a consumer age

Nick Seddon, November 2007

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… [Full Details]

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Articles for the Media

Give out student loans to make nursing an attractive career
Edmund Stubbs, Health Service Journal, December 2015

Britain's idea of ‘good healthcare' is threatening the NHS
Edmund Stubbs, Health Service Journal, October 2015

Can the NHS realise David Cameron's ambitions for seven-day services?
Edmund Stubbs, The Guardian, July 2015

Edmund Stubbs: The choice to pay for a 'turbocharged' NHS
Edmund Stubbs, The Yorkshire Post, February 2015

Fitness-to-practise investigations make sick doctors sicker
Dr Christoph Lees & Dr Hilarie Williams, Pulse, January 2015

Medical regulation: more reforms are needed (BMJ)
Dr Christoph Lees, September 2014

The Independent View: Could Ireland's emerging healthcare reforms test David Laws' NHIS vision?
Elliot Bidgood, Lib Dem Voice, December 2013

Is Britain's NHS in A&E? (Voice of Russia UK)
Dr Christoph Lees, November 2013

Local autonomy key to improving health outcomes
Elliot Bidgood, Hospital Dr, October 2013

Sweden's healthcare system shows what localism can achieve
Elliot Bidgood, The Guardian, October 2013

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