This research sought to understand the current state of community services and to explore how the health and care system needs to change to enable these services to meet the needs of the population now and in the future.
This report examines the content of the 44 sustainability and transformation plans (STPs) that were submitted in October 2016. STPs are the main vehicle for transforming health and care services in England in line with the NHS five year forward view. The report discusses the main challenges that lie ahead ...
As the NHS seeks to move away from competition towards integration and to develop new models of care, individuals and organisations across the health and care system need to learn to work together to make the best use of collective skills and knowledge. This paper offers those who are leading ...
This report looks at the reality of caring for acutely ill medical patients at the NHS front line and asks how care in hospitals can be improved. It comprises a series of essays by frontline clinicians, managers, quality improvement champions and patients, and provides vivid and frank detail about how ...
Sustainability and transformation plans (STPs) are key to the future of health and care services. This report, commissioned by the Mayor of London and based on work completed in March 2017, looks at the five STPs in London, their contents and common themes.
The authors, from The King’s Fund and ...
This report, commissioned by the Mayor of London, reviews the progress made over the past year by the capital’s five sustainability and transformation partnerships (STPs), new bodies established to implement local plans for the future of health and care services. It finds evidence of improvements in services for patients in ...
Based on interviews with eight of the 'first wave' integrated care systems, this report seeks to understand how they are developing and to identify lessons for local systems and national policy-makers.
Over the past decade a number of health policies have sought to put the patient first and to improve health outcomes. Choice and competition have been key elements of these policies, but the importance of integrated care was highlighted by Lord Darzi in the final report of the NHS Next ...
This report describes the different types of accountable care organisations (ACOs) emerging in the United States. It presents some early evidence on their performance, assesses the future for ACOs, and discusses the implication of these developments for integrated care initiatives in England.
This paper summarises presentations made at a seminar held at The King’s Fund in April 2010. The seminar brought together case studies from the NHS in England, Kaiser Permanente in California and the independent sector, as well as research evidence, to explore what has been tried and what has worked ...
As England’s population both expands and ages, so the demands on primary care will grow. Within the current commissioning and funding system innovative models of primary care provision are already being used. This report describes examples of these through four case studies in different areas of England. It also highlights ...
In 2014 The King’s Fund was approached by the health department in the Australian state of Victoria to undertake an independent review of the model of the state’s devolved governance of health services. This report presents the findings of our review, drawing on three visits to interview key stakeholders and ...
With a growing number of health care providers in deficit and others placed in special measures because of concerns about the quality of their care, the search is on to find ways in which they could be supported. Sir David Dalton’s forthcoming review provides a timely opportunity to explore the ...
This collection of essays, published jointly by the All-Party Parliamentary Health Group (APHG) and The King’s Fund, maps out health priorities for the next parliament, as seen from the perspective of key stakeholders in the world of health.
The NHS five year forward view (Forward View), published by NHS England and other national NHS bodies, sets out a shared view on how services need to change and what models of care will be required in the future. While the direction set by the Forward View has been broadly ...
Although the coalition government has pledged to protect funding for the NHS, the pressures to meet rising demand will put a strain on spending. Building on a previous analysis produced in association with the Institute for Fiscal Studies, this paper examines the gap between the likely available funding and the ...
This paper argues that the NHS in England cannot meet the health care needs of the population without a sustained and comprehensive commitment to quality improvement as its principal strategy. Despite a succession of well-meaning policy initiatives over the past two decades, the paper argues that the NHS in England ...
The aim of this report is to describe the approach taken to integrated care in Northern Ireland, Scotland and Wales with a view to drawing out the lessons for England. The report has been written at a time when policy-makers in England have made a commitment to bring about closer ...
The aim of this report is to provide an update on the service changes taking place in the NHS in London, and in particular to address the question of who will lead these changes in the NHS structures that came into effect in April 2013. The report builds on an ...
The aim of this paper is to support the process of ‘making it happen’ by summarising the steps that need to be taken to make integrated care a reality; we have drawn on our own work and that of others in areas where local leaders have identified
integrated care as ...
In June 2015, The King’s Fund was commissioned by the Department of Health to review how the performance of local health systems could be assessed. Our review looks at how to measure the performance of health services within CCG areas, including how well these services work with social care and ...
This paper aims to challenge those involved in integrated care and public health to ‘join up the dots’, seeing integrated care as part of a broader shift away from fragmentation towards an approach focused on improving population health. Using examples from organisations and systems in other countries that are making ...
This paper tells the story of the journey made by the District Health Board for Canterbury, New Zealand, towards its goal of providing integrated care for all. It looks at the drivers for change, the leadership values shown by key players and considers the lessons that can be learned from ...
This paper reviews the impact of three approaches to NHS reform in England since the late 1990s: targets and performance management, inspection and regulation, and competition and choice. It argues for a fundamental shift in how the NHS is reformed, learning from what has worked (and what has not) in ...
This paper explores the coalition government’s record on NHS reform by describing the situation it inherited when it came to power in 2010, the policies it has pursued, and (where available) evidence of their impact. It takes the stated aims of the reforms
as the starting point and reviews progress ...
The aim of this paper is to describe the different forms of integrated care and to summarise evidence on their impact. The paper is based on a major review published by The King’s Fund and has been prepared in the light of the increased interest in integrated care arising out ...
This paper has been written as a contribution to the work of the NHS Future Forum and in support of the government’s espoused aim of placing integrated care at the heart of the programme of NHS reform. Integrated care is essential to meet the needs of the ageing population, transform ...
Written as a contribution to the government's current listening exercise, this paper sets out the challenges facing the NHS and identifies the reforms we believe are needed to meet these challenges. We offer suggestions for revisions to the current Health & Social Care Bill and future policy development but we ...
In encouraging innovation and experimentation in health authorities the idea of a development agency for the N.H.S. has been explored under the aegis of the Royal Institute of Public Administration. This report examines the development agency model, setting out the case for an agency, presenting a range of critical appraisals ...
This paper seeks to analyse how the role of district health authority members developed in the period around and after the 1982 reorganisation of the NHS, and it seeks to identify how the role of members can be strengthened within the existing framework of the NHS. Some ideas and principles ...
The literature on geographical variations in health care is large and growing. A comprehensive review of this literature would be a major task and is beyond the scope of this paper. Instead, the paper summarises some of the key issues which emerge from the literature and identifies the implications for ...
This paper is concerned with policy making in the Swedish health service. The paper begins with a description of the organisation of the Swedish health service and a brief summary of the main issues of debate within the service. This is followed by an examination of the role of the ...
This report presents the results of the authors' review of experience of health care technology assessment in the UK and overseas. It was prepared principally to inform the programme of work on technology assessment being developed at the King's Fund Institute, and was a benchmark exercise, seekingto establish the state ...
In the current debate surrounding methods of health finance, there has been no shortage of proposals for reform, but there has been a serious shortage of careful analysis of these proposals. This is the main aim of this briefing paper. Through a systematic examination of policy choices, it seeks to ...
This paper reviews the available evidence on medical negligence and analyses the options facing policy makers. It shows that claim rates in the United Kingdom are much lower than in the United States. Differences between the two countries in legal, health care and social insurance systems mean that it is ...
This briefing paper analyses the management of clinical activity in the NHS. It does so against a background of increasing concern that practices are not always as effective or efficient as is sometimes claimed. The paper considers critically the various policy options that have been put forward for tackling this ...
The briefing paper provides a constructive analysis of the White Paper (Working for Patients). It argues that the White Paper outlines an ambitious and high risk strategy. The paper identifies main themes underlying the White Paper proposals: new institutional arrangements for the health services; the management of clinical activity; responsiveness ...
This study describes the various approaches adopted by some DHAs in separating responsibility for purchasing and providing services. The approach finding most favour involves separating the purchaser and provider functions below the DGM (District General Manager) level. The strength of this approach is in enabling the purchaser and provider functions ...
This report reviews the performance of health services in Sweden, Holland, West Germany, Canada and USA. The main aim has been to identify the countries' studies, to draw parallels with the UK, and to establish the lessons, if any, from abroad. Chapter one traces the origins of the Prime Minister's ...
The first part of this briefing looks at the implications of the NHS reforms in theory and in practice and presents the six lines of enquiry which might be pursued. The second section discusses the particular impact of the NHS reforms on London which has maintained a very significant number ...
The successful implementation of the NHS reforms hinges on the development of district health authorities as effective purchasers of health care for their residents. The NHS has always been provider driven and if services are to be delivered more efficiently and responsively then it is essential that health authorities are ...
This report looks at the new role of district health authorities as purchasers of services for their residents. The report shows that non-executive members have the following contributions to make to the work of their authorities: bringing a wider range of experience than is available among the executive members; ensuring ...
This report is based on a seminar held in Southampton in October 1991 which explored an alternative approach to health rationing from that of the Oregon experiment. A specially designed simulation exercise examined the dilemmas facing purchasers in the new NHS. Organised over 24 hours, the simulation centred on three ...
This book tells the story of Jaymee Bowen (Child B) whose case has come to epitomise the dilemmas involved in making tragic choices in health care. It shows that the story was complex and not simply an example of health care rationing. While media reports at the time emphasised the ...
This paper examines four major policy developments which are forcing changes in medical staffing arrangements and also in the reconfiguration of clinical services within and between hospitals. These developments are the primary care-led NHS, the New Deal on junior doctors' hours, the Calman report on specialist medical training and the ...
This report summarises the main results of a survey of approaches to commissioning. All health authorities were surveyed and a 100 per cent response was achieved. The survey sought to map different approaches to commissioning and to assess the impact of these approaches from the perspective of health authorities. The ...
This book is based on interviews with the four politicians who served as secretary of state for health between 1988 and 1997; Kenneth Clarke, William Waldegrave, Stephen Dorrell and Virginia Bottomley, and offers insights into the events of this period. The author explores the world in which the health secretaries ...
This book is a sequel to 'Tragic Choices in Health Care: the case of Child B', and continues the examination of ethical questions and conflicts of interest arising from priority setting and treatment decisions. Discussing five cases where funding of a treatment was refused or questioned, it assesses whether lessons ...