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Hugh Alderwick @hughalderwick.bsky.social · 12d

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

The Health Foundation @healthfoundation.bsky.social · 12d

After a year in power, has the Labour government set the foundations for ‘saving’ the NHS and delivering the ‘deep reform’ it said social care needed?

This new analysis provides an overall assessment of the direction and potential impact so far.

Read more ⬇️

Labour’s first year

Our report looks at Labour's record so far and offers an overall assessment of government's reform agenda on the NHS and social care.

bit.ly

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Hugh Alderwick @hughalderwick.bsky.social · Sep 4

Thank you! Late, but here

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Hugh Alderwick @hughalderwick.bsky.social · Aug 27

Lessons from history for bringing NHS England back into the department

The Health Foundation @healthfoundation.bsky.social · Aug 26

Following the decision to abolish NHS England, @agnesjuliet.bsky.social and @hughalderwick.bsky.social analyse the history of changes to NHS management, identify unresolved tensions that underpin them and set out implications for the latest round of reform.

Read more ⬇️
https://bit.ly/4mtiZB9

'The decision to abolish NHS England marks the end of a 12-year experiment of trying to run the NHS at much greater arm’s length from politicians – through a statutorily independent body, rather than NHS leadership embedded in the DHSC.' Hugh Alderwick
Agnes Arnold-Forster at the Health Foundation

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Hugh Alderwick @hughalderwick.bsky.social · Jul 28

Dazed and confused? Policy ideas behind the NHS 10 year plan

www.health.org.uk/reports-and-...

www.health.org.uk

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

@healthfoundation.bsky.social @charlestallack.bsky.social @mancunianmedic.bsky.social @martinmckee.bsky.social @helensalisbury.bsky.social

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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/...

Rhetoric about NHS reform is misplaced

The NHS is in crisis, and talk of fundamental reform is little more than a distraction The NHS in England is in crisis. The health service entered the new year—as it did the last one—with several NH...

www.bmj.com

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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...

The RAND Health Insurance Experiment, Three Decades Later

We re-present and re-examine the analysis from the famous RAND Health Insurance Experiment from the 1970s on the impact of consumer cost sharing in health insurance on medical spending. We begin by su...

pmc.ncbi.nlm.nih.gov

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

My colleagues summarised this and other evidence here:

www.health.org.uk/sites/defaul...

www.health.org.uk

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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...

How Do Health System Features Influence Health System Performance?

International comparisons are an important tool for benchmarking health system performance, shedding light on health systems’ relative strengths and weaknesses. The present work examines how different...

www.oecd.org

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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-...

www.health.org.uk

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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-...

Public Satisfaction With The NHS And Social Care In 2024 | BSA | The King's Fund

This report explores public satisfaction with the NHS and social care in 2024. Just 1 in 5 people in 2024 said they were satisfied with the NHS. This is the lowest level of satisfaction recorded since...

www.kingsfund.org.uk

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

The way the NHS is funded—largely through general taxation—is an efficient and equitable way of raising revenue, with comparatively low admin costs

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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/...

core.ac.uk

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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...

The dangers of magical thinking on health policy

We must carefully consider how changes in the funding model might affect the healthcare system

www.ft.com

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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...

Spending on health in Europe: entering a new era

Publicaciones de la Organización Mundial de la Salud

www.who.int

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Hugh Alderwick @hughalderwick.bsky.social · Jul 23

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

The NHS – a Suitable Case for Treatment? - Policy Exchange

Download Publication Online Reader ‘The NHS – a Suitable Case for Treatment?’ makes the case that the NHS is not fit for purpose and is in urgent need of reform.The report finds that NHS performance r...

policyexchange.org.uk

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Hugh Alderwick @hughalderwick.bsky.social · Jul 17

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-...

www.health.org.uk

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Hugh Alderwick @hughalderwick.bsky.social · Jul 4

@mancunianmedic.bsky.social @healthfoundation.bsky.social @hpiandycowper.bsky.social

Hugh Alderwick @hughalderwick.bsky.social · Jul 4

The 10 year plan—more hope than substance. My take in @bmj.com

www.bmj.com/content/390/...

Government’s 10 year plan for the NHS in England

Familiar ambitions; familiar questions about delivery The Labour government published its 10 year health plan on 3 July1—a year after it entered office. Life expectancy in the UK has stalled,2 and pu...

www.bmj.com

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Reposted by Hugh Alderwick

BJGP Open @bjgpopen.bsky.social · Jun 19

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.

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Reposted by Hugh Alderwick

The Health Foundation @healthfoundation.bsky.social · May 12

🎧 @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 ⬇️

The Lancet @thelancet.com · May 12

What might the anticipated 10-year plan for the NHS look like? What are the implications of dismantling NHS England? Will any government get a handle on social care?

🔊 Listen to a new episode of The #LancetVoice to find out more: www.buzzsprout.com/861868/episo... @gavincleaver.bsky.social

Labour's record on UK health - The Lancet Voice

Gavin and Jessamy welcome Dr. Hugh Alderwick from the Health Foundation to The Lancet Voice as we explore the impact of the Labour government's health policies since coming to power in the UK. What mi...

www.buzzsprout.com

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Hugh Alderwick @hughalderwick.bsky.social · Mar 28

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

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Hugh Alderwick @hughalderwick.bsky.social · Mar 28

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

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Hugh Alderwick @hughalderwick.bsky.social · Mar 28

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

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Hugh Alderwick @hughalderwick.bsky.social · Mar 28

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

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