New qual research on the changing role of ICSs in England, based on interviews with local leaders
Lots in there--including support for government's policy aims--but the ongoing mess of yet another NHS restructure is inescapable:
www.health.org.uk/reports-and-...
Great collaboration between @healthfoundation.bsky.social and @thisinstitute.cam.ac.uk
And good for @bmj.com @kamranabbasi.bsky.social publishing some qual!
Big qual study on access to general practice
Changes linked to 10 year plan offered some benefits, but also unintended effects—including undermining continuity and human connection, fragmentation of care, and widening inequities
Careful design, implementation, and evaluation of new services needed
Our new assessment of Labour's first year
Main story:
- Labour has set out a broad vision on the NHS
- But detail on how change will happen is lacking
- And resources to deliver are limited
- Standing back, it's hard to find a coherent policy agenda
- More reorganization will make it all harder
Thank you! Late, but here
Lessons from history for bringing NHS England back into the department
Dazed and confused? Policy ideas behind the NHS 10 year plan
www.health.org.uk/reports-and-...
@healthfoundation.bsky.social @charlestallack.bsky.social @mancunianmedic.bsky.social @martinmckee.bsky.social @helensalisbury.bsky.social
You'd want to design some exemptions and various rules... But—luckily—government already has a fairer and more efficient way of raising revenue for the NHS… tax!
We should focus on the real problems facing the NHS, not made up ones
www.bmj.com/content/380/...
And on more user charges (eg £X to see your GP), evidence tells us they can reduce demand for health care, but that includes the care people need to stay healthy
The poorest and sickest patients suffer as a result
pmc.ncbi.nlm.nih.gov/articles/PMC...
My colleagues summarised this and other evidence here:
www.health.org.uk/sites/defaul...
People want government to improve the NHS, not reform its funding model. This would waste years of time and money and would not address the NHS’s problems
Evidence on health system characteristics and performance points us to this conclusion too
www.oecd.org/en/publicati...
When presented with detail on how other models work—including social insurance, like in some European countries, or some version of our current model with additional user charges—they overwhelmingly favour sticking with our current tax-funded system
www.health.org.uk/reports-and-...
And despite low public satisfaction with NHS services, the public have strong support for the NHS’s model—free at the point of use, comprehensive, and primarily tax funded
www.kingsfund.org.uk/insight-and-...
The way the NHS is funded—largely through general taxation—is an efficient and equitable way of raising revenue, with comparatively low admin costs
In either case, there’s no clear evidence that one model performs better than the other
(and recent work suggests that, if you were starting from scratch, you would not choose SHI)
core.ac.uk/download/pdf...
onlinelibrary.wiley.com/doi/10.1002/...
Both systems basically rely on the same thing: risk pooling across the population, funded by compulsory payments (whether you call these a tax or not)
www.ft.com/content/602f...
How countries fund health care is shaped by history, culture, politics, values, more
The distinction between Beveridge (tax funded) and Bismarck (social insurance) systems has blurred over time, as countries with social insurance increasingly rely on extra government £
www.who.int/europe/publi...
Policy exchange, backed by Sajid Javid, think we need to switch the NHS funding model to social insurance, and introduce new charges for NHS services, like to see a GP
policyexchange.org.uk/publication/...
These are not new ideas, but they are bad ideas
A thread with some evidence
1 in 5 care workers live in poverty—much higher than the average UK worker. Poverty is even worse for migrant workers in social care
New analysis @healthfoundation.bsky.social
www.health.org.uk/reports-and-...
@mancunianmedic.bsky.social @healthfoundation.bsky.social @hpiandycowper.bsky.social
Illustrative
What’s been tried? A curated catalogue of efforts to improve access to general practice
➡️ doi.org/10.3399/BJGP...
Using 449 different sources, this review offers a comprehensive, thematically curated catalogue of attempts to improve access to general practice.
🎧 @hughalderwick.bsky.social joins @thelancet.bsky.social podcast to explore the impact of Labour's health policies since coming to power last July.
Also hear Hugh's analysis on the balance between funding and reform, the role of AI, and improving access to primary care.
Listen now ⬇️
Rejigging NHS structures while the health service is in crisis is a distraction that NHS staff and patients could do without. See more @healthfoundation.bsky.social
Government could achieve the same objectives with far less disruption—for instance, by bringing some functions into the department over time, leaving others at arms length from ministers, and avoiding distracting legislative changes needed to scrap NHS England entirely
But scrapping NHS England altogether will be a massive distraction. Evidence tells us that NHS reorganisations cause disruption and rarely deliver the benefits politicians expect. They also waste time and effort that could be spent on work to improve services
There is some logic in bringing NHS England and the department closer together—for instance, to reduce fragmentation and improve clarity for the health service
This morning on Today, #BBCRadio4 reported on our views on government abolishing NHS England
Here's the long version of what we think @bmj.com : www.bmj.com/content/388/...
Brief thread here with some key points:
