Dr Anna Dixon will leave her position as the Director of Policy at The King’s Fund and rejoin the Department of Health as Director of Quality and Strategy and Chief Analyst.

She will take up her new position in early May after spending more than six years with independent charitable organisation

Commenting on the appointment, Una O’Brien, Permanent Secretary at the DH, said the new recruit “brings expert insight in to a wide range of health and care policy.”

Before joining The King’s Fund, Dr Dixon worked in the Strategy Unit at the DH focussing on a range of issues including choice, global health and public health.

“I am delighted to be taking up this new role at the Department of Health at such a critical point when many organisations are taking on new responsibilities in the NHS and public health system,” said Dr Dixon.

“I look forward to working closely with colleagues in the Department as well as partners across the health and social care system to address the key strategic issues facing us, not least among which is the challenge of securing high quality care for patients and users.”

Hospitals across England are struggling to deal with real term cuts in funding imposed by the Government as part of its efficiency savings, the NHS’ economic regulator has warned.

Trusts across England are forecasting cuts of more than 8% over the next three years as the Government attempts to meet its target of saving £20bn by 2015.

But following a review of trusts’ three year plans Monitor said that hospitals need to make “significant changes” beyond efficiency savings to remain financially sustainable.

The review found that hospitals may be forced to reduce services in an attempt to meet financial targets – despite being tasked with treating the same amount of patients.

Hospitals across England have started to reduce their cost base by an estimated £7bn to meet Government targets. However, Monitor expects trusts with hospitals built using private finance initiatives and small general hospitals to suffer the most when aiming to cut costs.

Andy Burnham, Labour’s Shadow Health Secretary, accused the Government of making a “major mistake” in imposing harsh savings targets instead of finding cost-savings efficiencies.

“Eyes were taken off the ball just when the NHS needed its full focus on the money and this report suggests the NHS has failed to get ahead of the problem,” he said.

“Senior civil servants complain of how hard they have found it to get the Secretary of State on the seriousness of the financial challenge – a damning indictment of his time in office. This failure to plan is resulting in an increasingly crude approach to reducing costs and panic measures. Ministers are in danger of losing control of NHS finances and urgently need to get a grip.”

The King’s Fund anticipates that the outlook for hospital finances are bleak over the course of the next three years but is unsure how the cuts will affect standards of care. “The question is to what extent that will translate into a cut in quality or in the amount of care hospitals provide,” said Professor John Appleby, Chief Economist at the King’s Fund

The Government’s controversial NHS reforms have resulted in public satisfaction levels on the way the NHS is run fall by 12% in the last year, a new survey has shown.

The British Social Attitudes Survey showed how public satisfaction fell from 70% in 2010 to 58% in 2011 after the reforms came under increased scrutiny by the media and public.

John Appleby, Chief Economist at The King’s Fund – who sponsored the survey’s health questions – said he was shocked how quickly satisfaction levels had reduced.

The study questioned more than 1,000 people between July and November last year. It found that satisfaction with individual services also fell by 4% for GPs, 5% for inpatient services, 6% for outpatient services and 7% for A&E services.

Although the survey found the NHS to be performing well in other areas, The King’s Fund said the levels of satisfaction had been influenced by the Government’s reforms, publicised funding pressures and ministerial rhetoric.

“It is not surprising this has happened when the NHS is facing a well-publicised spending squeeze,” said Mr Appleby. “Nevertheless, it is something of a shock that it has fallen so significantly. This will be a concern to the Government, given it appears to be closely linked with the debate on its NHS reforms.”

Mike Farrar, NHS Confederation Chief Executive, said it was “really important” politicians and NHS leaders are “engaging the public in the major debate about the NHS” to improve satisfaction levels.

“The NHS has got to respond to massive financial pressure and the changing nature of health and social care in a way that takes patients and the public with us,” he said. “It will be much harder to make the changes to services necessary if public perception and confidence deteriorates.”

Public satisfaction with the NHS had risen steadily over the previous decade before the most recent findings – the biggest fall in a year since the survey began in 1983.

Joint-working between pharma companies and clinical commissioning groups (CCG) could lead to GPs becoming commercially biased, a new report has warned.

The Quality of GP Prescribing suggests that doctors may favour medicines from pharma companies that offer discounts or preferential deals instead of cheaper generic alternatives.

Despite Government plans to increase joint-working in an attempt to reduce costs, the report by The King’s Fund says the approach “may not be truly cost effective”.

The report highlighted a study from Liverpool University academics in 2003 that found that almost half (49%) of practitioners said the pharmaceutical industry was their main influence on which new medicines they prescribed.

This compared to 17% of GPs who preferred to use academic and professional literature as their main source of information to forge an opinion.

The report also calls for “urgent revision” on the system which causes branded generics to undercut generic prices in the Category M basket of medicines.

Category M was introduced into the Drug Tariff six years ago to adjust the reimbursement prices of more than 500 medicines.

But The King’s Fund report says the current system can encourage a switch back to more expensive brand prescribing which counters years of favouring cheaper generics, and is also confusing for patients.

The Government needs to make significant changes to its health reforms and deliver a new model of integrated care to meet the challenges the NHS faces, says The King’s Fund.

A new paper, Where next for the NHS reforms? The case for integrated care, calls for the NHS to be re-orientated and based on stronger collaboration between health professionals and more effective organisation of services.

Chris Ham, The King’s Fund’s Chief Executive, says that integrated health care “offers the best prospect” of enabling the NHS to succeed in the future.

The report, written as a contribution to the Government’s current listening exercise, draws evidence from the NHS and the US which shows how closely-aligned care delivers better outcomes for patients with long-term conditions.

The Fund backs the need for reform, but it argues that changes must be made on a clear diagnosis of NHS performance and the difficulties it is expected to face.

It has called for a series of amendments to be made to the Health and Social Care Bill and wider health policy if the NHS is to deliver integrated care. These include that Monitor should be re-defined to allow the regulator to promote both competition and collaboration.

The main bodies involved in commissioning and providing health care should be under a duty to work together to achieve a goal of delivering integrated care, and GPs and specialists should work together to overcome “historic divisions within the medical profession”, the papers says.

The NHS’ payment systems should be reformed to encourage the delivery of high-quality, co-ordinated care and avoid perverse incentives to increase hospital treatment, the paper advises.

“We welcome recent indications that this argument is being heard within Government,” said Chris Ham. “But moving to an integrated health system requires more than a change in political rhetoric and a few tweaks to the Health Bill – it means making significant changes to health policy to ensure that integration is hard-wired throughout the NHS.”

Moving forward, the paper also highlights radical proposals to relax the current purchaser/provider split and enable groups of GPs and specialists to form ‘integrated care partnerships’ that provide, as well as commission, services.

The NHS is under-managed, over-administered and is in urgent need of a new style of leadership, a report from The King’s Fund Commission says.

The future of leadership and management in the NHS: No more heroes highlights how excellent managers can deliver the productivity improvements and service transformation the Government requires.

Professor Chris Ham, Chair of the Commission and Chief Executive of The King’s Fund (pictured), says that politicians must “resist the temptation” to listen to public opinion of NHS management.

A survey by the Local Government Association in July last year found that the public’s top choice for spending cuts was NHS managers (69% approval).

But the report, which followed a nine month inquiry by the Commission, found that high quality, stable management is key in provided high-performing health services. Yet across the NHS, the average chief executive spends just 700 days in their post.

This reflects a culture where ‘heroic’ leaders focus on issues from the top of the organisation, are ‘parachuted in’ to replace other managers or seen solely as trouble-shooters, the report highlights.

A new type of ‘shared leadership’ is advocated by the Commission, involving bosses at different levels of the workforce working alongside those involved in patient care to improve services, rather than tackling specific problems.

Evidence was examined from the UK and international healthcare services and found that, given its size and complexity, the NHS is actually under-managed, but over-administered. The Commission found that no assessment of the future needs of the NHS has been made, yet the coalition Government has already imposed a 45% cut in management posts and a 33% reduction in administration costs.

Other key findings included that an urgent assessment of the information demands placed on the NHS is needed to deal with the numerous NHS administrators that have? developed; NHS organisations should take responsibility for their? own leadership development and quality of management; and work that has began to strengthen leadership and development should be continued through the creation of an NHS Leadership Centre.

“The priority for the future NHS must be to deliver the best care possible to those with chronic and long-term conditions,” said Professor Ham. “That needs a new style of NHS leader, as adept at building partnerships to deliver care across boundaries as they are at managing their own services.”

The NHS currently has approximately 45,000 managers – although many clinical managers are excluded from this definition.

The NHS could save hundreds of millions of pounds each year if general practice improves its quality of patient care, a report by The King’s Fund has found.

A major inquiry found that at least £200m a year could be saved by more efficient prescribing of drugs and £700m by improving the management of medical conditions in the community.

Sir Ian Kennedy, Chair of the inquiry’s panel (pictured), says that GPs must “seize the opportunity” provided by the introduction of GP commissioning to improve services and quality of care.

Improving the quality of care in general practice: Report of an independent inquiry commissioned by The King’s Fund concluded that the majority of care provided by general practice is good.

However, there are widespread variations in performance and gaps in the quality of care delivered which GPs need to improve.

Questions were raised over the variations in the quality of clinical care after analysis found that one-third of patients with stomach or oesophageal cancer that require urgent referral to hospital are given a non-urgent referral.

Differences in the experience of patients and co-ordination of care were also found during the inquiry.

To correct the variations found, the report encourages GPs and other primary care professionals to build on the changes taking place and transform the way general practice operates by:

· accelerating the trend for practices to work as multi-professional teams

· delivering a ‘new deal’ for patients

· accelerating the shift away from small practices working in isolation towards ‘federated’ networks of practices working more closely with one another and with other professionals, and

· practices looking ‘beyond the surgery door’ by focusing on prevention, taking a more active role in public health issues such as obesity, and reaching out to deprived communities.

The report adds that is strongly endorses the principle that GPs should be generalists rather than specialists. But with GPs set to be given the majority of the NHS’s budget and a central role in implementing the Government’s health reforms, it calls for general practice to “embrace radical change” if it is to maintain its international reputation for excellence.

Chris Ham, Chief Executive of The King’s Fund, hoped the findings would “spur” GPs and others working in general practice to accelerate the pace of change.
“Although general practice in this country remains the envy of the world, there is no room for complacency,” he said.

“While many practices have been at the vanguard of innovation and quality improvement, too many GPs remain unaware of significant variations in performance and do not give priority to improving quality.”

Nigel Edwards is to leave the NHS Confederation after 12 years.

The acting Chief Executive has decided not to apply permanently for the position and will join The King’s Fund and Nuffield Trust think tanks in policy research roles.

Mr Edwards says there are “plenty of people” in the organisation who can fulfil the role of CEO when he departs in July.

He joined the Confederation back in 1999 as Director of Policy and was recently placed 25^th in the 2010 HSJ 100 list of the most influential people in health.

The Confederation hopes to appoint a permanent chief executive by the time of its annual conference in July.

The scale and speed of the proposals outlined in the Government’s Health and Social Care Bill could destabilise the NHS, critics have warned.

The proposals include giving GPs control of up to 80% of the NHS budget and SHAs and PCTs being scrapped and turned into Foundation Trusts by 2014.

Dr Hamish Meldrum (pictured), Chairman of Council at the British Medical Association (BMA), said that committing to the reforms was “a massive gamble”.

But Health Secretary Andrew Lansley argued that modernising the health service was a “necessity not an option”.

“We need to take steps to improve health outcomes, bringing them up to the standards of the best international healthcare systems, and to bring down the NHS money spent on bureaucracy,” he said.

“This legislation will deliver changes that will improve outcomes for patients and save the NHS £1.7 billion every year – money that will be reinvested into services for patients.”

Under the plans more than 150 NHS organisations will be abolished as GPs take on responsibility for commissioning local services to improve patient outcomes. The BMA says it supports a greater involvement for clinicians to plan NHS services but other parts of the Bill threaten the benefits of clinical-led commissioning. It highlights that under the proposals competition will be forced upon commissioners, even if they believe the best services can be provided by hospitals.

“Forcing commissioners of care to tender contracts to any willing provider, including NHS providers, voluntary sector organisations and commercial companies, could destabilise local health economies and fragment care for patients,” said Dr Meldrum.

“Adding price competition into the mix could also allow large commercial companies to enter the NHS market and chase the most profitable contracts, using their size to undercut on price, which could ultimately damage local services. Dr Meldrum added that forcing trusts to achieve foundation status before they are ready could impact on patient levels of care. He said the BMA would lobby very hard to amend “the most damaging aspects of this legislation”.

Chris Ham, Chief Executive of The King’s Fund, said the proposals could ‘destabilise’ the health service, calling the Bill the “biggest shake-up of the NHS since its inception”.

“The last decade has seen significant progress in the performance of the NHS,” he said. “While ministers are right to stress the need for reform to make it truly world class, these gains are at risk from the combination of the funding squeeze and the speed and scale of the reforms as currently planned.

“But, while the Government’s reforms have the potential to improve the NHS, they will be implemented against the backdrop of the biggest financial challenge in its history. Finding the £20 billion in efficiency savings needed to maintain services must be the overriding priority, so the very real risk that the speed and scale of the reforms could destabilise the NHS and undermine care must be actively managed.”

Ham said the Government should instead adopt a flexible approach to implementing the reforms and that MPs and peers should understand the difference between well executed changes that deliver results and those which will undermine the NHS as they continue to debate the Bill in Parliament.

Continuity of care in general practice is more important than improving access, according to the results of a recent survey into GP opinion.

Over 55% of respondents to The King’s Fund’s survey of GPs and practice-based professionals said that providing continuity of care should be the main priority for improving the quality of general practice in England.

Managing long-term conditions was the second most important, voted for by 40% of respondents, while just one in five (20%) thought that access to care should be prioritised. Other top priorities were health prevention (28%) and end-of-life care (25%).

The survey was commissioned to complement The King’s Fund’s Inquiry into the Quality of General Practice in England and collated the views of 843 individuals working in general practice.

The findings are consistent with recent research for the Fund that showed patients would generally opt for better continuity of care over speed of access when given a choice.

Nick Goodwin, Senior Fellow at The King’s Fund and Director of the GP Inquiry, said: “While access to GP services is clearly important and has been the focus of recent NHS reforms, GPs and patients alike are telling us that continuity of care should be a significant aspect in delivering quality improvements in general practice.”

Findings from The King’s Fund’s Inquiry into the Quality of General Practice in England will be published in the New Year.