Many of the potential pitfalls of increasing purchaser plurality in the NHS are relevant in planning and developing general practitioner led locality commissioning. However, this involvement in commissioning or purchasing maternity care may actually provide the 'bite' necessary to move reluctant provider trusts more quickly towards services which meet the ...
The 1997 white paper 'The New NHS: modern, dependable' promised to put quality at the heart of the health service, announcing the formation of a National Institute of Clinical Excellence, a Commission for Health Improvement, evidence based National Service Frameworks, a new system of clinical governance in NHS trusts and ...
Considerable management challenges must be faced in order to ensure the successful operation of primary care groups (PCGs). The insights to be gained from those involved in total purchasing pilots (TPPs) are likely to prove valuable in informing the development of PCGs, and workshops were held to capture some of ...
This report is the third in a series of papers. It focuses on the evaluation of intermediate care services. Previous work has dealt with a conceptual framework to clarify understanding of intermediate care, and with issues of implementation. In the last year, interest in intermediate care has made an exponential ...
In the spring of 1996, the Implementation Group of North Thames Research and Development allocated £50000 to each of thirteen health authorities for evidence into practice implementation projects. In autumn 1996, the King's Fund Management College was commissioned to evaluate the 17 approved projects. This is the second of three ...
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 report presents the findings of a project that aimed to understand the present state of knowledge of the clinical effectiveness of rehabilitation using the evidence of systematic reviews. Fifty-six systematic reviews covering a variety of disabilities, health problems, diseases and client groups were identified through a literature search. Data ...
The authors evaluated the implementation of Health at Work, a national programme of work which has begun to open up the workplace health agenda as an organisational and leadership development agenda. Through their research and evaluation strategy they established that: workplace health interventions can make a positive difference to workforce ...
This report describes the planning, implementation and outcomes of a process for involving local citizens and users and their organisations in informing the NHS Confederation's conference 'All Our Tomorrows' in July 1998, to celebrate 50 years of the NHS. The King's Fund was invited to contribute to the design and ...
While most GP practices participating in total purchasing have some experience of contracting with health care providers, the extension of their responsibilities has, in many cases, taken them into entirely new areas and posed a set of challenges for primary care-based purchasing. This paper concentrates on a central element of ...
In a previous working paper the results of a survey of the contracting arrangements of the 53 first wave total purchasing pilot (TPP) projects during 1996-97 were given. This working paper reports the results of a follow-up survey carried out for the 1997-98 contracting round. The survey was designed to ...
This briefing paper summarises the key findings of two literature reviews jointly commissioned by the Audit Commission and the King's Fund. The reviews provide evidence of shortcomings in the current health and social care system and practices and processes that are known to be effective in achieving good outcomes for ...
This book is published to mark the 50th anniversary of the NHS. It traces chronologically the major achievements and events in medicine, nursing, hospital development, primary health care and health management. The introductory chapter describes the health services in 1948. The next five chapters each cover a decade, and begin ...
This paper offers a way of thinking about the purpose of partnership; partnership behaviours which fit different purposes; and partnership behaviours which can lead to sustainable change and are not dependent on injections of external resources. The authors have created a typology which focuses on the purpose of partnership, in ...
The purpose of this paper is to report initial results from studies of the management costs, associated with TPP and to explore the relevance of current experience for the costs of establishing the new Primary Care Groups (PCGs) outlined in the Labour government's white paper on the NHS. The methodology ...
This paper looks at the government's plan for action zones in education, employment and health which aim to break out of the cycle of deprivation. It examines how the many individuals, groups and organisations who will be involved in the action zones will work together. The authors feel that if ...
This review examines the meaning of rehabilitation, the provision of it and responsibilities for rehabilitation services within health and social care, and trends in the availability of provision. It concludes that there is increasing awareness of the importance of rehabilitation but, in practice, opportunities for it are not being fully ...
This Review is based on the financial year 1996 to 1997. The first part examines the main events of the year in five key policy areas: creating the new NHS ; community care ; public health strategy; serving the consumer; and clinical knowledge. The second part of the work contains ...
The evaluation of Total Purchasing Project (TPP) initiatives in the field of continuing and community care was designed to provide answers to three key questions: to what extent were the TPPs aware of the policy consensus that has emerged in relation to the planning and delivery of continuing and community ...
In the 1960s, the King's Fund caused a major stir when it developed a new specification for hospital beds. Manufacturers implemented the specification as the 'King's Fund bed', which was revolutionary in its time and a major step forward in patient care. Today, more than 30 years later, the bed ...
In the 1960s, the King's Fund caused a major stir when it developed a new specification for hospital beds. Manufacturers implemented the specification as the 'King's Fund bed', which was revolutionary in its time and a major step forward in patient care. Today, more than 30 years later, the bed ...
In the 1960s, the King's Fund caused a major stir when it developed a new specification for hospital beds. Manufacturers implemented the specification as the 'King's Fund bed', which was revolutionary in its time and a major step forward in patient care. Today, more than 30 years later, the bed ...
Six citizens' juries pilot schemes, sponsored by the Institute for Public Policy Research and the King's Fund, took place in the NHS between June 1996 and March 1997. This book evaluates all aspects of this experiment, from an explanation of the background to the pilots to descriptions of the jury ...
This is a review of intensive care and high dependency care at Southampton University Hospitals NHS Trust, which followed on from a trust-wide organisational review carried out in the previous year.
This working paper is the first report from the national evaluation of total purchasing pilot projects to provide evidence on the achievements of all 53 'first wave' pilots in England and Scotland. It also looks at the range of factors associated with more and less successful total purchasing in 1996-97 ...
This report draws together the interim findings from the first two years of a three year evaluation of all first and second wave TPPs in England and Scotland which began in October 1995, led by the King's Fund. The report discusses whether first wave TPPs have developed the organisational requirements ...
The aim of this working paper is to present a profile of the thirty-five second wave Total Purchasing Pilots (TPPs) in England and Scotland as part of the national evaluation of TPPs. Its objectives are: to describe the basic characteristics of the second wave TPPs, particularly highlighting similarities and differences ...
Innovations introduced into the NHS such as total purchasing (TP) have raised issues about information requirements and information technology. Information and information systems for TP are inadequate, with major problems being centred on a lack of guidance on specific systems for TPPs and an absence of software standardisation. Poor activity ...
There have not been any set criteria against which to assess the merits of the various ways in which total purchasing has developed nationally. An important part of the evaluation of total purchasing in the first year was, therefore, an attempt to derive success criteria which would enable comparison between ...
This paper examines what is known about linkworkers, using information derived from a review of the literature and from interviews with those working in the field. It discusses how linkworkers might make a contribution to primary care in the future, and considers some of the organisational issues that will need ...
In September and October 1997, the King's Fund held two seminars for the professions allied to medicine (PAMs) in order to discuss their actual and potential contribution to public health. This contribution is varied and spans the categories of input to commissioning, health promotion, clinical effectiveness and evidence-based practice, and ...
This bulletin is based on ideas developed from two seminars for professions allied to medicine (PAMs) organised by the King's Fund in order to discuss their actual and potential contribution to public health. This bulletin covers the subject areas of what PAMs do in relation to public health, health promotion, ...
This paper explores the many meanings of democracy, seeks to define some criteria for assessing whether or not there is a 'democratic deficit' in the NHS, and examines the policy options that have been put forward for making the NHS more 'democratic'. The first section analyses the various ways in ...
This paper draws on the findings of three studies of the management costs of total purchasing (National Management Functions and Costs Study, and two studies undertaken as part of the National Evaluation of the Total Purchasing Pilots), to shed some light on the management costs of Primary care Groups (PCGs). ...
In the 1960s, the King's Fund caused a major stir when it developed a new specification for hospital beds. Manufacturers implemented the specification as the 'King's Fund bed', which was revolutionary in its time and a major step forward in patient care. Today, more than 30 years later, the bed ...
The findings outlined in this book describe a service in inner London that cannot be sustained because it is unable to meet the demands imposed upon it. Services in outer London are comparable with those in other English cities. The mental illness services are in a state of transition, and ...
This paper reconsiders the meaning and impact of projects, the most common device for spending development monies. They argue that projects can distort the priorities of the host organisation. There are four aspects to this problem: the disruption caused to an organisation by the existence of a project; the project ...
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 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 ...
There has been little research undertaken into disabled women's sexuality. What there is has been carried out largely by non-disabled professionals. The subject remains controversial, capable of provoking extreme reaction, misunderstanding and prejudice. This book is the first major piece of research on disabled women's sexuality undertaken in the UK ...
This study describes the aims, methods and interim findings of a study to evaluate the impact of total purchasing and extended fundholding on the provision of mental health services. All baseline telephone interviewing has now been completed and the authors report on findings from the analysis of semi-structured telephone interviews ...
This report looks at how the Patients' Charter has worked in the past and and what patients and NHS staff would like to see covered in a future health charter. It is based on research commissioned by the NHS Executive and the King's Fund to help the Labour government review ...
This research was carried out at the request of the Northern Ireland Health and Social Services department to complement the work undertaken by the King's Fund for the NHS Executive on the English Patient's Charter. The aims were to establish whether patients, carers and staff views and experiences of the ...
This document includes extracts from the progress reports provided by four local projects as background to the discussions at the PACE Project Group meeting on 15 July 1998. The extracts include material to describe 'the lessons and factors for success which have emerged from managing your projects'. The reports included ...
This paper looks at definitions of different types of accountability, political and administrative, and at the accountability of health authorities, GP fundholders and the pilot projects for total purchasing. The research has revealed models of financial, managerial and public accountability which are described. The paper concludes with discussion of the ...
This book is designed as a series of personal reflections on three pilot citizens' juries in health authorities around the country. The first chapter consists of a historical perspective on the contribution that citizens' juries may make to democratic practice. It concludes that a clear understanding of the objectives of ...
Patients need easy-to-understand and accurate information in order to make informed choices about their medical treatment, but they are not getting it. In the first study of its kind, this book reviews the quality of leaflets, videos and audio-tapes through the eyes of both patients and clinical specialists. Specific areas ...
A major policy concern for the NHS is how to deal with the increase in emergency hospital admissions widely observed in the 1990s. This paper presents a systems approach to understanding the way in which unpredictable events are dealt with by health care services. It does this by developing a ...
This working paper is about engaging with older people around the development of community services. It sets out to do three things: make a case for engaging with older people to find out about their lives and the support they may require as they become ill or frail and to ...
This report aims to describe the experience and adequacy of budgetary and risk management arrangements of all first wave Total Purchasing Pilots (TPPs) in 1996/97. The results of a postal questionnaire sent to every TPP manager were analysed. The authors conclude that TPPs have taken seriously the management of expenditure ...
These comments on the Green Paper on public health, 'Our Healthier Nation', reflect the views of a group of individuals from a wide range of local and national agencies with a role to play in implementing the national public health strategy. These views were expressed during three seminars jointly organised ...
The Government's eagerly awaited White Paper on health aroused no great passions when it was launched at the end of 1997. Unlike its predecessor, the 1989 Conservative White Paper "Working for Patients", Labour's "The new NHS" has prompted no battle of words or major health debate. Yet in this, warn ...
This report presents interview and focus group findings in Tameside. It looks at carers' backgrounds, their experience of access to services, with special reference to the assessment process, and their views about services currently received. The 'Key Messages' section at the end summarises the carers' views about desirable outcomes and ...
This report presents interview and focus group findings in Southwark. It looks at carers' backgrounds, their experience of access to services, with special reference to the assessment process, and their views about services currently received. The 'Key Messages' section at the end summarises the carers' views about desirable outcomes and ...
This report presents interview and focus group findings in Hertfordshire. It looks at carers' backgrounds, their experience of access to services, with special reference to the assessment process, and their views about services currently received. The 'Key Messages' section at the end summarises the carers' views about desirable outcomes and ...
This report presents interview and focus group findings in East Sussex. It looks at carers' backgrounds, their experience of access to services, with special reference to the assessment process, and their views about services currently received. The 'Key Messages' section at the end summarises the carers' views about desirable outcomes ...
This report presents interview and focus group findings in County Durham. It looks at carers' backgrounds, their experience of access to services, with special reference to the assessment process, and their views about services currently received. The 'Key Messages' section at the end summarises the carers' views about desirable outcomes ...
This report presents interview and focus group findings in Bolton. It looks at carers' backgrounds, their experience of access to services, with special reference to the assessment process, and their views about services currently received. The 'Key Messages' section at the end summarises the carers' views about desirable outcomes and ...
'The Health of Londoners' is the first public health report for Greater London. London lags behind other UK and European cities in its lack of a strong city-wide approach to health and this report is a vital initial step in putting the health of Londoners on the map. The report ...
The Carers Compass has been launched by Carers Impact to help health authorities, NHS trusts and primary care groups to become responsive to their needs. The Compass reflects the work being done by the 19 Carers Impact sites across the country. The Compass points to eight key things carers need ...
This book - developed from a systematic review of evidence about the impact of the NHS internal market - asks what lessons can be learned from the internal market reforms, and how this knowledge can be used to aid policy-making in the future. It synthesises all the evidence on the ...
There are nearly 40,000 residential and nursing homes in the UK and choosing one of them, often under great speed and stress, can be a daunting experience. It is difficult to know what to look for, how to check that the standards are high, who funds what, and why there ...
This publication contains the organisational standards for nursing and residential homes produced after three years of development and trialling. It also contains a short account of the development of the standards and the process of using them in both nursing home and residential homes contexts.
This publication is a short report on a 1998 visit to Barcelona to investigate the planning and delivery of health care in Catalonia and explore the potential for mutual exchanges of staff.
This second study from the Changing Days project is a practical guide on how best to achieve the integration of adults with learning difficulties into the community. It builds on the vision set out in the first book, Changing Days, and reflects the experience of working in five sites around ...
This report summarises a meeting to evaluate the Carers Impact Project in Tameside. It reviewed the changes which have taken place during the course of the project and the impact on carers' lives, identifies what has helped and hindered progress, identifies how the work can continue, and evaluates the Carers ...
This report summarises the material produced by a workshop which was set up in response to feedback from local carers who took part in the first stage of the Carers Impact Project in Tameside. The workshop aimed to review the progress made in implementing the Carers Act and undertaking carer ...
This is a report of a workshop to take forward the issues raised by carers in Tameside. It summarises current work taking place to implement the Tameside Strategy for Carers and proposals on new structures to progress the carers strategy and a three part action plan relevant to carers from ...
This report summarises a meeting to evaluate the Carers Impact Project in Southwark. It reviewed the changes which have taken place during the course of the project and the impact on carers' lives, identifies what has helped and hindered progress, identifies how the work can continue, and evaluates the Carers ...
This report summarises the material produced by a workshop which was set up in response to feedback from local carers who took part in the first stage of the Carers Impact project. The workshop aimed to review the progress made in implementing the Carers Act and undertaking carer assessments and ...
This report summarises a meeting to evaluate the Carers Impact Project in Hertfordshire. It reviewed the changes which have taken place during the course of the project and the impact on carers' lives, identifies what has helped and hindered progress, identifies how the work can continue, and evaluates the Carers ...
This report summarises a meeting to evaluate the Carers Impact Project in East Sussex. It reviewed the changes which have taken place during the course of the project and the impact on carers' lives, identifies what has helped and hindered progress, identifies how the work can continue, and evaluates the ...
This report summarises the material produced by a workshop which was set up in response to feedback from local carers who took part in the first stage of the Carers Impact Project in East Sussex. The workshop aimed to agree good practice in carer assessments and to consider ways of ...
This report summarises a meeting to evaluate the Carers Impact Project in Bolton. It reviewed the changes which have taken place during the course of the project and the impact on carers' lives, identifies what has helped and hindered progress, identifies how the work can continue, and evaluates the Carers ...
This report summarises the material produced by a workshop which was set up in response to feedback from local carers who took part in the first stage of the Carers Impact Project in Bolton. The workshop aimed to agree good practice in carer assessments and to consider ways of ensuring ...