In 2008 the NHS celebrates its 60th birthday. This briefing looks at key health care issues over the last 60 years and forward to its 120th birthday. [Introduction]
General practice has changed considerably over the past decade. Practice size has increased, the workforce has grown and become more diverse, the range of services offered has expanded, and the contracting and financing arrangements for GPs have changed. Current government policy aims to improve access and choice for patients, to ...
For the past three years patients referred by their GP for a specialist outpatient consultation have had a choice over where to be treated. As part of a larger research project, a survey was sent to patients in four case study areas of England to ask them about their experience ...
NHS spending in England may have more than doubled in real terms since 1999/2000, but the prospects for future funding now look bleak. Although there is consensus that the NHS faces a tough financial future, there is no agreement about just how cold the financial climate will be. Starting with ...
Primary care trusts (PCTs) spend around 75 per cent of the NHS budget in England. How do they decide on their spending priorities? This paper examines the data collected by the Department of Health on the amounts PCTs spend on the 23 programmes of care based on medical conditions such ... and An update to the briefing "Local variations in NHS spending priorities" published in 2006.
Workforce planning for the NHS is a large undertaking. The NHS in England employs approximately 1.3 million staff, 70 per cent of recurrent NHS costs relate to staffing, and more than £4 billion is spent annually on staff training. Securing a sufficient number of staff with the appropriate skills and ...
Recognising the significance of mental health in terms of both expenditure and the overall health of the population, the King's Fund commissioned a review. This report presents current and projected needs for mental health services and their related costs. It gives details on a number of specific disorders, including depression, ...
Practice-based commissioning (PBC) has been a major strand of NHS policy since 2005. There continues to be a high level of commitment to the policy among GPs, but many still remain hesitant about its impact to date and unsure if its potential will be fulfilled. In 2007, The King's Fund ...
How are top-ups distinct from other charges in the NHS and why have they become such a contentious issue now? This briefing gives some background on the relevant legislation and guidance in this area. [Introduction]
As the government seeks to accelerate change in the NHS and make services more responsive to public demands, the argument for market discipline versus planned provision is being hotly debated: can a highly centralised system sit comfortably alongside a market-led approach?; can market forces provide an effective response to the ...
This report brings together the findings and conclusions from three strands of research that addressed different aspects of the main research topic, which is the identification of successful strategies for sustaining reductions in waiting times. They are: identifying successful strategies for sustaining reductions in waiting times; the impact of waiting ...
Technology is widely used in many areas of life, and the NHS Next Stage Review highlighted the role that technology can play in improving health outcomes. However, the use of everyday technologies such as email and online booking systems is poor in the health service. This report aims to improve ...
This note responds to the Department of Health's review, led by Professor Mike Richards, into the consequences of additional private drugs for NHS care.
'Free choice' - allowing patients being referred for non-urgent treatment to choose a hospital anywhere in England - begins in the NHS in England in April 2008. It is another milestone in a policy that aims, among other things, to use consumer pressure to improve the quality of hospital services ...
Attempts to give more choice to users of public sector services has been a major theme of the Labour government's public sector modernisation programme. Policies have been developed in health care, education and social housing that aim to give users a greater choice of publicly or privately owned providers, and ...
The NHS has rarely managed to balance its books exactly; in many years it has overspent, and in some it has carried a surplus. In the financial year 2005/6 it is likely to record a substantial overspend - in gross terms, around £900 million, equivalent to around £700 million net ...
The NHS has moved from an overall net deficit to a net surplus within a year, according to the figures released by the government in June 2007 (Department of Health 2007), reversing a three year trend towards increasingly large gross deficits. The government argues that these latest figures show that ...
Practice-based commissioning (PBC) is a policy intended to give more decision-making power over NHS resources to general practitioners (GPs), and allow them to design and deliver completely new services or commission others to do so. It has a number of underlying policy objectives including delivering more cost effective and convenient ...
Anna Coote is the Director of the Public Health Programme at the King's Fund. and This is a summary of the report of the same name. The NHS is more than a provider of health services. It is the largest single organisation in the UK. Its potential impact on health, the environment, and the social and economic fabric of our lives is vast. Claiming the ...
This report considers issues facing stakeholders in London who are working on two problems: "how do we build healthy and safe communities in the capital?" and "what role does the NHS have in improving community safety?" It is written for policy makers and practitioners in the NHS and its partner ...
This research summary outlines recent King's Fund work on waiting times, supported by the Department of Health. The research set out to learn from three groups of hospitals: those that have proved able to sustain reductions in waiting times; those with variable performance and those with a poor record on ...
In the wake of the NHS Plan, the King's Fund brought together a group of commentators, academics and practitioners from health and other sectors to consider the best ways forward. This discussion paper presents a broad analysis of current problems and three approaches to change. It identifies three immediate and ...
This briefing provides a review of progress made since the BBC's 2002 'Your NHS' day on the five top priorities voted for by the public as the issues that mattered most in the NHS. These priorities were: free long-term care for older people; better pay for NHS staff; shorter waiting ...
A wide range of public services - including higher education, housing associations and public service broadcasting - are now either funded, delivered, or regulated through agencies working at 'arm's length' from government. Is it time to consider a similar model for the modern NHS? Does the health service need to ...
The National Health Service (NHS) in England is in a state of transition as the government pushes forward a programme of significant reform. If the government achieves its stated objectives, the NHS will be transformed from a state-owned commissioning and provision system to one in which care is delivered by ...
This independent audit was commissioned by the Sunday Times and is published with their kind permission. and The Labour Party came to power in 1997 promising to 'save' the NHS. Since then, it has found unprecedented increases in funding for the health service, but Prime Minister Tony Blair has emphasised that the extra money must be linked to a 'step-change' in reform. This reform has taken four ...
There are significant recruitment and retention problems in nursing in the NHS. Nurses are leaving the NHS at a faster rate than they are being recruited. A review of the existing literature and research undertaken over the last 15 years has highlighted a number of apparently consistent themes in barriers ...
The primary task of the health service is to improve people's health. A fundamental goal within this is to improve patients' health-related quality of life (HRQoL). But, while measuring and monitoring many aspects of its performance, the NHS does not routinely measure the impact of its care on patients' HRQoL. ...
Nine NHS walk-in centre pilot sites opened in London during 2000. Six of the nine centres are located in hospital sites. The other three centres are in Soho in central London, the High Street in Croydon, and Parsons Green in Fulham. NHS walk-in centres are nurse-led and offer primary care ...
The Wanless review Securing our Future Health, published by the Treasury in 2002, concluded that the United Kingdom would need to spend substantially more on health care and that fundamental reform would be needed to enable those resources to be used effectively. Five years on, The King's Fund has commissioned ...
Agenda for Change is the most ambitious pay reform introduced into the NHS. In addition to simplifying the system of pay, its objectives were to improve the delivery of patient care as well as staff recruitment, retention and motivation. This paper examines progress in implementation based on interviews with key ...
Investment in the NHS has increased significantly under the Blair government. Spending will soon reach the EU average, but when we catch up with our European neighbours, what then? Assuming that pressures to spend more will continue, but that marginal health returns on extra investment are likely to diminish, this ...
NHS trusts spend about £500 million a year on food and catering. The government is committed to the economic, environmental, social and health benefits of sustainable food procurement, but this is difficult to translate into practice at a local level. In 2004 the Better Hospital Food Programme (BHFP) commissioned the ...
The specific dynamics of the London health care labour market, and the challenges they create for recruitment and retention, were highlighted in the 2003 King's Fund report 'In Capital Health?'. In the 18 months since, a number of important and far reaching changes have been initiated across the NHS. This ...
This publication lays out the questions the government must answer if it wants to place patient choice at the heart of a taxpayer-funded health care system, including how extra costs will be met, whether patients are willing and able to exercise choice in their own best interests, and what kinds ...
In March 2005, the King's Fund published An Independent Audit of the NHS under Labour (1997-2005), which included an analysis of where extra NHS funding had been spent. This briefing provides an update to the question "where's the money going?" It analyses new data recently released by the Department of ...
In recent years the NHS has made significant progress in increasing the number of non-executive directors (NEDs) from black and minority ethnic (BME) communities, as part of a wider move to reflect diversity at all levels of NHS organisations. Drawing on the findings of two surveys and interviews with individuals ...
This is the executive summary of a research summary which examines a key aspect of NHS staffing: that of the loss of experience from health services as older staff, who are valuable and much needed, leave early in ever-increasing numbers. With a workforce where about 150,000 of the one million ...
While working as a volunteer at the Latin American Elderly Project, a day centre in Islington, Lucrecia Janowicz recognised that the older members of the project were unable to access the health information that they needed because they didn't speak English. She therefore decided to organise a series of talks ...
Local accountability has been a significant policy issue within the NHS generally. However, primary care trusts are in the main accountable to the centre and there have been calls to review this. This paper discusses a range of options for reforming the relationships between PCTs and their public. It explores ...
The need to wait for health care has been a feature of the NHS since its inception. When Labour came to power in 1997, total numbers of patients waiting stood at 1.3 million: the highest since the NHS began in 1948. The government announced its 'war on waiting' and pledged ...
This book is described as being a 'reflective tour of where the NHS is coming from, the world it is likely to face in the 1990s, and some ways in which we could strengthen it'. It covers demography, social and environmental stress, medical developments, public expenditure constraints, and likely themes ...
This paper explains initially why health authority management should introduce ethnic monitoring systems and deals in later sections with how members and managers should use the data to measure and improve their authority's equal opportunity performance. The bulk of the paper is, however, addressed to personnel and other officers who ...
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 ...
This edition of the annual publication contains articles on hospice care, job-sharing in the NHS, research ethics committees, day surgery, resource allocation, optical services, cost effectiveness in the NHS, long-term care insurance and hospital care at home.
This background paper marks the 40th anniversary of the NHS not so much by celebrating past achievements but by addressing some of the issues which are critical to the establishment of an effective agenda for health in the 1990s and beyond. Areas covered are the health debate including financial reform; ...
Public, political and professional pressures have led to a greater interest in quality assurance in the NHS, but there has been no national policy or framework prescribed. The development of, and approach to, quality assurance has therefore varied widely between districts and between regions. This report aims to reflect managerial ...
The development of a network of services and support for people with A.I.D.S. is a challenge for voluntary agencies, for the NHS and for local authorities. There is a consensus that services should, as far as possible, be provided to enable people to be cared for in their own homes. ...
The report examines the likely impact of the indicative drug budgets for family doctors and the government's general practice fund holding initiative in Britain. The authors believe that the new arrangements will sharpen price competition in the UK medicines market, and welcome this. The study also reports on recent European ...
Despite forty years of the NHS, there are continuing geographical variations in the provision, use and outcome of health services. These variations are manifested in the greater availability of doctors and hospital beds in some areas than others; differences in the use made of these doctor and beds; and variations ...
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 introduction of general management into the NHS has transformed the service. The author asks if the NHS can continue to evolve into a more dynamic, responsive and actively managed service, representing even better value for money or will the transition to general management be arrested?
The Single European Market has nearly arrived when people will experience freedom of movement of goods, services and people between the Member States of the European Community. For the health service, this has two main concerns. First, the possible increase in the migration of unskilled labour will effect the health ...
This book provides a detailed discussion of the organisation of postgraduate medical education in the NHS, and the administrative and financial implications if changes are to be made. The material is organised within a 'demand and supply' framework: demand from employers, notably the NHS, and supply provided by various institutions ...
This report examines the present state of the 1987 expenditure plans in the light of the most up to date information available. It discusses the different ways in which public expenditure can be measured, followed by an examination of expenditure on Hospital and Community Health Services during the 1980's. The ...
This is the fourth paper published by the King's Fund and NAHA on the need to change the way in which pay is determined in the NHS. This paper outlines a proposed structure for determining pay, based on principles described in the earlier documents. The system has three elements: a ...
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 ...
The Task Force was established in 1986 to help health authorities to implement equal opportunities policies for all racial groups in the health service. This 'model' policy has been created from a number of policies sent to the Task Force by health authorities, using those sections which seem most suitable ...
This book questions how much the public really knows and cares about the standard of care and about the priorities for expenditure on and within the health and social services; how well informed are people (including health services staff) about the facts and figures of these services and about the ...
This report contains the findings of a survey of ex-national trainees who are not currently working in the NHS. A surprisingly large number of trainees left the Service before reaching senior positions. Not only did this represent a waste of the money and manpower which had gone into their training ...
The aim of the seminar was to identify the importance of clarifying the role and relationships of functional managers and unit administrators if the strengthening of administration at operational level was to be achieved. Functions represented were confined to general administration, catering, domestic management and works. Organisational principles, the development ...
Reuse of single use equipment raises many issues, including legal and ethical ones. This report is the proceedings of a King's Fund conference. The following topics are covered: 1. General perspectives of the various groups involved; 2. Clinical issues; 3. Legal and ethical implications; 4. Technical issues; 5. Economic issues; ...
This study arose from an invitation from the King's Fund to study the job of the district administrator in the NHS and to find out what it is really like. 41 senior administrators were interviewed and eight of them observed at work for three days. The findings show wide variation ...
This report discusses the special problems of managing health services. It compares the development of management training in the NHS with that of other public services, with an analysis of the role of universities, the DHSS and the NHS authorities; and outlines a future strategy.
This report makes observations which it hopes will be of use to the Royal Commission. There are five observations on the `Royal Commission on the National Health Service': morale in the National Health Service; the role of the district; management training; the role of the volunteer; community health councils. The ...
This book explains - in simple and clear language - the value and use of statistical information as an important management tool. The author shows how the content, organisation and presentation of data can illuminate the goals which an authority sets itself and the way it intends to achieve them. ...
This book aims to stimulate discussion and action about the serious difficulties facing the NHS in industrial relations. It aims to help the development of more effective industrial relations which the NHS badly needs and looks at how improvements might be made realistically within the current framework of management. Chapters ...
The author has written an invaluable record of the events surrounding the introduction of the National Health Service by researching among contemporary documents. The scope of the account is limited to England and Wales, and there has been no attempt made to assess and judge the emergent NHS from the ...
This report contains the findings of a survey of chief officers on management teams in the NHS in England and Wales. The survey, carried out in 1981, was part of an initiative by the King's Fund to develop a management education programme for the most senior officers in health services ...
During 1984, the King's Fund and the National Association of Health Authorities agreed to set up a joint working party, under the chairmanship of Lady McCarthy, to review the present system of pay determination in the NHS and to make recommendations for reform. This report covers the present Whitley Council ...
This project paper has been produced from a working seminar for senior management in the NHS. This seminar was to discuss with experts in the field of pay determination and the problems of pay in the NHS. The first section of the report outlines aims and assumptions. Further sections deal ...
This short book has been prepared to mark the first five years of Community Health Councils' (CHCs) existence. They came into being in 1974 when the NHS underwent a major administrative reorganisation. Nothing quite like them had ever existed before in the form of a special statutory body with the ...
Race and Employment in the NHS is based on a conference organised by the King's Fund and the Polytechnic of the South Bank which examined the practical steps that health authorities and managers should take to ensure equal opportunities for people from ethnic minority groups. This booklet describes ways in ...
This project paper summarises the results of a survey of youth training in the NHS. The survey looked at the extent of involvement by the NHS in the Work Experience on Employers' Premises (WEEP) Scheme sponsored by the Manpower Services Commission and at the youth training being undertaken more generally. ...
The first section of this paper examines the need and demand for dental health. It discusses how treatment is provided in the United Kingdom and how the National Health Service is meeting the need. Objectives of dental health services are defined and positive steps towards their attainment suggested. The latter ...
In June 1979, the King's Fund arranged a two-day seminar for nurse managers to consider the Thwaites Report "The Education and Training of Senior Managers in the National Health Service." Following the seminar, a group of senior nurse managers and educators with a responsibility for management training met regularly at ...
Section one of this report deals with consumer involvement in the NHS. It covers the areas of complaints procedures, the role of community health councils, the voluntary contribution to the NHS, the Wolfenden Report and patient participation in general practice. The second section concentrates on community health councils (CHCs), presenting ...
The decision making process in area health authorities is often slow. This is because of the absence of formal management arrangements, the complexity of the consultative machinery and consensus decision making. The case for speedy decision making in the NHS is discussed, expectations and reality are compared and possible remedies ...
In July 1978, the King's Fund held a conference to discuss the report Education and Training of Senior Managers in the National Health Service, commonly referred to the Thwaites report after the chairman of the working party. This publication is not just an account of the conference, but a personal ...
The basis of the project paper reports a study of area management teams carried out in England by Rockwell Schulz between January and March 1981. Perceptions of consensus management are discussed with a study of the roles of individual team members and the influence of others such as local authorities, ...
The purpose of the Centre Lunch Talks has been to invite some distinguished person to speak for half and hour on a topic related to health and welfare services with the aim of stimulating new thought or action.
These papers complement a wide variety of material made available to the Commission on health service finance. The first paper discusses the alternative models of financing health services. The second paper describes one of those models as used in the NHS: health service charges. The third paper discusses efficient management ...
The Royal Commission on the NHS made an early decision to consider the objectives of the NHS, what they should be and how far the NHS does and may succeed in reaching them. The first paper is a personal statement by one of the members of the Commission. The second ...
The paper begins with a background study on hospitals in the National Health Service by the Secretariat of the Royal Commission on the NHS. Hospital types and numbers are investigated including district general hospitals, community hospitals, teaching and specialist hospitals, followed by a discussion of specific aspects of the hospital ...
This paper presents an analysis of the factors underlying the conflict over the pay beds issue which erupted in 1974-76; a conflict which some consider to have been one of the precipitating reasons for the appointment of the Royal Commission. The first section of the paper sets out the basic ...
This study complements a wide variety of material made available to the Royal Commission on manpower planning in the NHS. The first paper, by Alan Williams, is a consideration of some of the manpower problems facing the Commission within a general theoretical context. The second, by the secretariat, describes existing ...
The purpose of the seminars was to inform staff in Great Britain about health services in Europe. This document contains the transcripts of talks given by English-speaking representatives from European Community countries who spoke about the planning and organisation of health services in their respective countries.
Increasing expectations of social service departments and the need for social work to establish itself as a new and independent profession has led to friction within the NHS. Although the NHS is not the largest customer for social service departments, many patients and clients are the same people. Services have ...
This project paper has been compiled as a result of workshops and conferences on unit management held at the King's Fund College and King's Fund Centre, February 1980 - February 1982. The challenge for management at unit level is to improve efficiency, monitor standards, simplify decision-making processes and carry out ...
In evidence to the Royal Commission, a frequent complaint was that the reorganised structure with its principle of consensus management had led to massive delays in decision-making. Previous studies have examined the process of decision-making through interviews with a sample of NHS staff. The paper reproduced here explores the feasibility ...
Among the initiatives launched by the Steering Group was a study involving five district health authorities to review the operational information required about doctor-patient relationships and contacts, and to develop effective ways of collecting the data required. Participants undertook a comprehensive review of the organisational structures and management arrangements which ...
This paper contains the results of part of a study relating to the information flow in and out of and within the district office. No attempt has been made to prescribe in detail a total system but it is hoped that the general principles and approach described will assist district ...
The purpose of the conference was to discuss the report of the King's Fund Working Party on The Organisation of Hospital Clinical Work (KF Project paper no. 22). Discussion centred on the main recommendation that medical work should be performed by fully-trained doctors. The implications were: a reduction in the ...
This publication contains proposals formulated by members of a workshop held in June 1983 about the development of a district policy for the introduction of information technology with particular emphasis on the implementation of computerised departmental information systems.