Analysis of the Quality and Outcomes Framework Report for the NHS.

This policy paper evaluates the progress that QOF has made since its introduction and considers the different ways in which the QOF can be reformed. It specifically looks at the role the QOF can play in tackling health inequalities, which is widely recognised as a persistent health challenge confronting the UK. Using expert opinion and stakeholder analysis, the Bow Group’s detailed analysis concludes that one of the major problems informing the QOF is its perverse nature. For a framework that claims to be about quality and outcomes, the QOF is operationally geared towards emphasising process and targets. The report recommends that in order to drive up standards, there is an urgent need for a greater emphasis on outcomes indicators over process. It argues that whilst there is a clear role for process measures in supporting the foundations of the QOF, there is a real danger that a lack of focus on outcomes can drive down standards and result in perverse incentives for healthcare professionals and in turn unintended outcomes. The report also finds that the QOF’s performance in reducing health inequalities has been at best mixed and at worst disappointing. Under the QOF, GPs working in inner-city areas may feel they have to work much harder, and invest more practice resources, to perform well against outcome-based quality targets. In order to counter this, the report recommends that the QOF should be reformed to contain an appropriate incentives structure to support GPs working in deprived areas.

'The Right Track' Delivering the Conservatives’ Vision for High Speed Rail

For the last four months the Bow Group’s Transport Committee has analysed the various proposals which have been submitted to the Government to build the next phase of high speed rail (HS2) in Britain, connecting London with Birmingham and the north. The Bow Group’s detailed analysis, as set out in the attached pamphlet pdf, concludes: · The Government risks choosing the wrong route for Britain’s second high speed railway to connect London with Birmingham, Manchester, Leeds and Scotland. · HS2 should initially be directly linked to Heathrow Airport through the construction of a Heathrow hub interchange station combining HS2, the Great Western Main Line, Chiltern Line, Crossrail and Airtrack services. Other British airports such as Birmingham and Manchester should also be directly linked to HS2. · Heathrow is one of the most difficult national airports in Europe to reach by rail, thus forcing many potential travellers to use other European hub airports. eg, from Bristol alone over 10,000 passengers per week fly to other European hub airports to interline. A Great Western high speed link would allow them to use Heathrow instead. They choose to interline elsewhere due to poor rail access to Heathrow. · Successful HS2 connection through Heathrow will mean more flights from the airport in the long term as more people choose to use the airport. · Without direct HSR connection to Heathrow road traffic congestion and pollution around the airport and the M25 will continue to be amongst the worst in Europe. · The Government must not just listen to the rail industry when making its choice for the route of HS2. British Rail was wrong in its choice for the first section of high speed rail, between London and the Channel Tunnel in the 1980s, and a better route, promoted by Lord Heseltine, was chosen. · A non-direct HSR link with Heathrow and other airports, represented by a loop or spur line, would represent folly in Britain’s ambition to develop a truly integrated transport policy. · A successful national high speed rail network should directly connect all of Britain’s major airports and cities as is successfully reflected in France, the Netherlands, Belgium and Germany. · Britain’s traditional North/South economic divide can be bridged by a successful HSR network as it will better bind and co-ordinate economic progress, as has been achieved in France in areas such as the Pas de Calais and the Alsace regions. · The Conservative Party is right to support a direct HSR link with Heathrow. It must move quickly when in Government to secure a ‘quick win’ and ensure a smooth and swift planning environment is in place. · HS2 linked to Birmingham and Manchester Airports will allow these airports to better utilise spare slots and compete more effectively with the congested south east airports NOTES 1) The Right Track – Delivering the Conservatives’ Vision for High Speed Rail by Tony Lodge, with a foreword by Lord Heseltine, is published at 0930 on January 20 2010 2) Tony Lodge is the Chairman of the Bow Group Transport Committee. Lord Heseltine is the former Conservative Cabinet Minister who supported and approved the route for the Channel Tunnel Rail link, now known as High Speed 1. He supported an approach into London from the east, and not the south as suggested by British Rail. This route allowed for the huge regeneration of what is now known as the Thames Gateway.

''More for Less'' Cutting Public Spending, Protecting Public Services

This pamphlet looks at the main departmental budgets and identify what the Government is spending, how much they think they need to cut to balance the books, and what can be done to deliver greater efficiencies and value for money without harming essential front line public services.

By 2025 the number of people aged 85 or older in England is set to increase by 70% to nearly two million. In this group more than a third of men (37%) and more than half of women (55%) live alone. Most have a limiting long term illness. Responding to the Government’s Green paper on social care ‘Shaping the Future of Care Together’, the University of Leeds and the Bow Group today produce new research which shows Telecare offers a proven “win-win” for the health and social care system. Telecare helps sick, disabled and older people remain at home for longer by supporting them 24/7 with alarms, alerts, health monitoring and communication.

Today the Bow Group are kindly publishing my pamphlet “Revolving Dore”. My experiences in the Courts over many years have made me increasingly concerned about the value for money of our Young Offender Institutions. The cost of a place in one of these is well over £30,000 per year and, in terms of re-offending rates, they are a dismal failure. The pamphlet raises serious issues amongst which are: the link between literacy, school exclusions and crime; the lack of emphasis at Young Offender Institutions on education; the lack of sport and in particular team sport; and the high number of hours young people spend each day locked up doing nothing constructive. One conclusion I come to is that short sentences (anything under 12 months) are a complete waste of time. No course of activities that would seriously curb re-offending can be completed in such a short space of time. Any offence not worth twelve months should be dealt with by a community punishment. I conclude by stressing the need for a comprehensive re-settlement programme, with a re-settlement wing in every Young Offender Institution which ensures that on release from custody youngsters go to decent housing, a job, or continuing education. If we don’t have an effective re-settlement policy inevitably it will mean the “revolving dore”.

So in the spirit of asking the unthinkable, Crossbow poses the question – "Full marks, Marx?"

Two industry experts reveal fresh evidence that the NHS postcode lottery is alive and well at a PCT near you. 

Prof. Regina Herzlinger of Harvard uses shocking international comparisons to reveal the failure of the NHS to deliver consistent quality of care. She argues that the root cause of this is lack of innovation, resulting from insufficient consumer choice. All Britons get the same state monopoly insurer, whether they like it or not. As long as this is the case, genuine innovators - the Bransons and Dysons of healthcare - won't enter the industry. In the absence of real innovation, the only way to respond to spiralling demand with finite resources will be rationing and waiting.

This is the first time Prof. Herzlinger - an advisor to numerous members of Congress, described by "The Economist" as "America's leading expert on consumer-oriented health reform" - has devoted a paper exclusively to health reform in the UK.

The Failed Generation: The Real Cost of Education under Labour

This report, as part of the Bow Group’s Invisible Nation series, highlights the total number of pupils who have taken their GCSEs under Labour. It discovers that an entire generation of almost 4 million pupils have failed to gain their expected qualifications of five good GCSEs including English and maths, and approaching a million pupils who have not gained five GCSEs of any grade. Despite an increase in education spending of 75%, over £70.5 billion has been spent on educating pupils who failed to gain the qualifications now expected in the modern day workplace.