Yes / Personalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the ‘framework approach’ described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK.

Yes / The International Centre for Participation Studies and Sharing Voices Bradford (for information on these organisations, see Appendices 3 and 4) maintain that participation is an important part of a healthy democracy, with benefits for all. However, participation can be anything from empowering to tokenistic, and must be critically examined if we are to understand how to use it effectively. This paper considers the contribution of participation to improved service delivery in the health service. For beneficiaries, participation can be about ownership and responsibility for the services we use, as well as rights and the chance to express what we want from them. For service providers, participation is widely recognised as an effective way of tailoring services to the needs of the different communities they serve. The NHS and other service providers have made great strides in developing mechanisms for participation by service users. However, these do not always reach all sections of the community. Many individuals feel sceptical about getting involved, unconvinced that their contribution could make a real difference. Through the Participation ¿ Why Bother? workshops, we set out to explore these feelings, to reflect on perceived barriers and identify changes that might help overcome them. The aim was not to look at the substance of service delivery issues, but to try and work out how the process of involving people in decision-making in the NHS could be improved, to make it easier for voices from Black and Minority Ethnic (BME) communities to be heard. / Bradford District Care Trust; South and West PCT; City tPCT

The perceived decline in care and benchmark standards is arguably a product of competing benchmarks and the decline of traditional mentoring approaches positioned with the patient experience at its core.

Yes / The NHS will need to make real term cost savings whilst maintaining and, where possible, enhancing the quality of essential services. The require-ment for efficiency savings to enable reinvestment in quality is estimated to be up to £21.1 billion by 2014 (Department of Health, 2010; Appleby, 2009.). This requires the NHS to increase productivity by 6 percent per annum (Appleby, 2010) while the Office of National Statistics estimates that productivity1 actually fell by approximately 0.3 percent per annum over the period 1995-2008 (ONS, 2010). Productivity is highly variable within the NHS and even within trusts (NHS Institute for Innovation and Improvement, 2004). Given these pressures, the productivity of healthcare organiza-tions is an incredibly salient topic; lean management is a particular pertinent and topical issue.

No

No / The NHS has always been a bargaining chip for politicians. Cuts to budgets; an ageing population; and more complex, comorbid long-term conditions have placed greater demands on health and care services. There continues to be pressure on GPs, community services, and the voluntary and social care sectors. Now that the political parties have presented their manifestos for the NHS, we need to consider what is right for patients and local communities.

The potential impact of the autumn statement on the future healthcare workforce.

Yes / In March, the Department of Health (DH) released the Learning from Mistakes League, in which NHS organisations are ranked by levels of openness and transparency (DH, 2016). While a welcome first step toward the centralised and open promotion of learning since the publication of the Francis and Berwick reports three years earlier, unfortunately, the league can be considered misleading for a number of reasons.

Yes

Yes / There is increasing recognition among policymakers that health systems are no longer fit for purpose. Our hospital-centred systems, originally created to deal with communicable disease epidemics, are now faced with the challenge of delivering care to the exponentially increasing number of people living with (typically multiple)≈non-communicable disorders (NCDs). Global economic stagnation has also contributed to the pressures facing health systems – such that there is an imperative to develop new models of care.