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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.


Updated - International Health Care Outcomes Index 2022

Updated - International Health Care Outcomes Index 2022

Tim Knox, July 2022

This updated comparison of global health systems places the UK second to bottom across a series of major health care outcomes, including life expectancy and survival rates from cancer, strokes and heart attacks. New data is included for health spending for 2020 and life expectancy and mortality rates. This comparative study ranks the performance of the UK health care system with that of 18 comparable… [Full Details]

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China’s presence in NHS supply chains

China’s presence in NHS supply chains: Why we need to protect our health service from future threat

Robert Clark and Richard Norrie, May 2022

This new Civitas report takes a closer look at Chinese-manufactured goods in NHS supply chains and discovers the NHS is “dangerously reliant” on China for medical supplies. This analysis by Robert Clark and Dr Richard Norrie finds 1 in 6 (17 per cent) products contained on the Government’s “Disaster Relief List” are sourced from China. In the last year the UK government has… [Full Details]

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A Response to the Race and Health Observatory (RHO) rapid evidence review into ethnic inequalities in healthcare

A Response to the Race and Health Observatory (RHO) rapid evidence review into ethnic inequalities in healthcare

Dr Richard Norrie, April 2022

Unequal health outcomes have become the subject to increased political attention in recent years. Richard Norrie, director of the statistics and policy programme at Civitas takes a look at the NHS Race and Health Observatory (RHO) as a case study and its work to ‘identify and tackle ethnic inequalities’ in health. The RHO exists to bring about equality of outcomes in healthcare, despite the fact… [Full Details]

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Unravelling the Covid State: From parliamentary democracy to the regulatory state?

Unravelling the Covid State: From parliamentary democracy to the regulatory state?

Dr Jim McConalogue, December 2021

Britain’s past and current ‘Plan B’ responses to Covid-19 marks the emergence of a new phase in the growth of ‘the regulatory state’ – a new report published by Civitas suggests – in which, crucial decision-making is outsourced to leading quangos. In this new report, Jim McConalogue finds ‘Future reforms need to recognise that the Covid-19 government decision-making process has appeared to… [Full Details]

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An independent appraisal of the NHS Workforce Race Equality Standard (WRES)

An independent appraisal of the NHS Workforce Race Equality Standard (WRES)

Dr Richard Norrie, December 2021

The NHS seeks to monitor and control diversity and equality through a programme known as the Workforce Race Equality Standard (WRES) – it is based on a series of statistical indicators pertaining to outcomes between white and non-white minority groups. However, as the Director of the Statistics and Policy Research Programme at Civitas, Richard Norrie, argues, closer inspection of those indicators reveals ‘they do not… [Full Details]

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Solving the Social Care Dilemma?

Solving the Social Care Dilemma?: A Responsible Solution

Peter Lilley, March 2021

There was a glaring omission in the recent White Paper on reform of the NHS: it contained nothing about the long-promised reform of finance for Social Care – despite Covid having further undermined care homes’ perilous finances. Like its predecessors, this government has been unable to resolve the two competing challenges. On the one hand, the pressure on local authority social care budgets cannot be… [Full Details]

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What price lockdown?

What price lockdown?

Tim Knox and Jim McConalogue, December 2020

As the UK government publishes its cost-benefit analysis of lockdown, Tim Knox and Jim McConalogue attempt to quantify the estimated costs that have been incurred in a new Working Paper, The cost of the cure. Their estimates can be used as a benchmark against which the government analysis can be measured. They find that the cost per year of life saved (QALY) ranges from… [Full Details]

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Is Coronavirus unprecedented?

Is Coronavirus unprecedented?: A brief history of the medicalisation of life

David Martin Jones and Emma Webb, July 2020

The coronavirus that had been declared a pandemic by the World Health Organisation (WHO) in March 2020 has frequently been viewed in society as unique, exceptional and unprecedented. In this report, David Martin Jones and Emma Webb suggest there is nothing particularly novel about disease in the human experience – and cautions that we are desperately in need of some historical perspective. This historical recounting of… [Full Details]

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The Road to Recovery

The Road to Recovery: Reviving Manufacturing after Coronavirus

John Mills, July 2020

The global economy may well take much longer to recover fully from the shock caused by the coronavirus crisis than many initially expected – and hoped. With business closures and lockdowns forecast to throw the world into the deepest recession since the 1930s Great Depression, John Mills, the UK entrepreneur and economist with a life-long political background in the Labour Party, suggests that the UK… [Full Details]

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Covid Kids

Covid Kids: The response of schools to coronavirus

Joanna Williams, July 2020

In response to coronavirus, schools closed to all but the children of key workers on 20 March 2020. The majority of children did not return before the end of the academic year, meaning they will have spent over five months out of the classroom. Schools remained closed to most pupils for such a long time because of government social distancing requirements and the teaching unions… [Full Details]

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A hat trick of failures

A hat trick of failures: How ‘the Blob’ led the British Government down the wrong path

Jim McConalogue and Tim Knox, June 2020

Britain has achieved an undesirable hat trick of failures in its Covid-19 pandemic response. Jim McConalogue and Tim Knox argue in this report that: Along with Spain, Britain has the highest excess death rate per capita in the world for the first half of 2020. The government’s reaction to the Covid-19 pandemic has also been one of the most financially expensive of… [Full Details]

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The Corrosive Impact of Transgender Ideology

The Corrosive Impact of Transgender Ideology

Joanna Williams, June 2020

In less than two decades ‘transgender’ has gone from a term representing individuals and little used outside of specialist communities, to signifying a powerful political ideology driving significant social change. At the level of the individual, this shift has occurred through the separation of gender from sex, before reclaiming biology through an innate sense of ‘gender-identity’. In this report, Joanna Williams argues that this… [Full Details]

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Year of the Bat

Year of the Bat: Globalisation, China and the Coronavirus

Niall McCrae and M.L.R. Smith, May 2020

The Covid-19 pandemic has exposed the underlying flaws of globalisation. The ideology of globalisation based on the notion of an increasingly borderless and interdependent world and in which the nation state would whither, is now seriously in question. In this book, Niall McCrae and M.L.R. Smith argue that, as the virus proliferated, China tried to cover up the contagion and did little… [Full Details]

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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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