Nigel Edwards
@nedwards_1
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Health and healthcare policy expert
London
Joined December 2010
Very interesting history of the growth of corporatisation of healthcare in the USA. A Gilded Age for Patients? The Broken Promises of Profit-Driven Medicine | New England Journal of Medicine
nejm.org
Understanding today’s corporatization of U.S. health care requires seeing it from a historical perspective, as a process that began with a change in the business model of care delivery in the 1920s.
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Very funny and thoughtful show at Soho Theatre by the superb @aliterative There are tickets
sohotheatre.com
A Comedy Show About Writing A Book About Romance
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This needs a BMJ VIewpoint not just a thread.
Consultant WRs are an excellent example of 'distributed cognition', where 'mental processes' and analysis occur across 'a collection of individuals and artifacts and their relations to each other in a particular work practice'. In ye olden days, a consultant WR would have.2/.
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RT @leonoramerry: A decade working with @nedwards_1 drummed into me the importance of thinking about the theory of change sitting underneat….
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RT @NuffieldTrust: The 10 Year Health Plan is full of ideas, but how will they happen?. Former Nuffield Trust chief executive @nedwards_1 h….
nuffieldtrust.org.uk
In this guest blog, Nigel Edwards argues that the new 10 Year Plan has plenty of good ideas, but the past would tell us that it’s a lot easier to suggest such ideas than to implement them, not least...
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Woring at the top of the licence' is a classic bit of misguided Taylorism - who does this? Respite from less demanding work is vital.
@nedwards_1 2. If clinical professionals only work "at the top of their grade" with the most complex/challenging cases, it is a recipe for burnout, with no respite whilst some more straightforward cases give breathing space.
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As for savings: Implementing skill mix changes is often complex and initially increases costs because of the need to retrain staff and replace existing ways of working. The problems above might errode the savings 5/5.
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This means while the task itself may be done competently the opportunity to identify other issues may be lost or other important elements of work are not properly carried out. The complexity of staff roles may not be properly appreciated leading to problems 4/5.
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The task being reallocated may actually be part of the process of gathering information about the patient’s condition and entangled with other important elements of the work.(Stalpers et al., 2025) 3/5.
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This may also make it more difficult for staff to gain experience of dealing with patients holistically and the benefits of being able to deploy professional judgement may be lost.(Maxwell & Leary, 2020) 2/5.
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My take from the literature: 1/5.The fragmentation of job roles into tasks can increase coordination costs, put a higher burden on senior staff who have to oversee the work of juniors and risk disrupting continuity of care.
I can't begin to wrap my head around the implications of this statement. Fundamentally misunderstands:.- intimate connection between clinical decision making and task.- how professionals are trained.- what professionals DO.- what regulators do (regulate professionals!)
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The NHS Plan says 'By 2035, we anticipate half of all healthcare interactions will be informed by genomic.insights and other predictive analytics.' I wonder where this comes from? And what it means. Any thoughts?.
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RT @ShaunLintern: My family had a recent experience of hospital care & we saw effect of this type of taskification of care. Pointless delay….
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RT @DrLKVaughan: Excellent piece on the Ten Year Plan from Jessica Morley (late of this parish) over on Linkedin. Counters the over-egged….
linkedin.com
The long-awaited NHS 10-Year Plan has finally arrived—eight years to the day since I first joined the Department of Health and Social Care. Calling it a "plan" might be generous, given the delivery...
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RT @TJCoats: Reasons to keep taking a history:.1) Anchoring bias is the commonest cause of error in acute care. 2) It’s not what the patien….
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Good that the ICBs are going to be 'encouraged' to be coterminous. There was a danger of the NHS drawing lines on maps that meant little to the people or other institutions that live there. Something that the UK has form on and generally does not end well.
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Is being a high performing FT going to equip you to be a realy good population health manager and care integrator? It might but I don't think it follows.
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But, to be fair it then does a reasonable job of trying to explain how this will be dealt with. It's not clear if the structural stuff will overcome the culture.
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