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 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; ...
This report is intended to share the learning which a group of NHS managers derived from an exploration of total quality management (TQM) in the NHS. It sets out to examine the relevance of TQM to the NHS, points out some of the challenges posed by it, and suggests a ...
This background paper forms a contribution to the seminar. The author is the Vice-Chancellor of Academic Affairs, University of California. This paper accompanies KFC 79/179
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 ...