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 report draws on recent research with vanguard sites in England, conducted in partnership with the Royal College of Psychiatrists. It finds that where new models of care have been used to remove the barriers between mental health and other parts of the health system, local professionals saw this as ...
This is one of a series of case studies exploring how individuals living in London have used the King's Fund Millennium Awards scheme to make a real difference to the health of others in their communities. While working at a west London community centre, Imo Akpan recognised a reluctance among ...
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 ...
The government’s proposed reforms to the health and social care system include clear aspirations for the voluntary and community sector as a provider of health services, a source of support for commissioning and a partner in tackling health inequalities. However, the reforms also present a number of challenges and risks. ...
Variations in health care in the NHS are a persistent and ubiquitous problem. But which variations are acceptable or warranted – for example, variations driven by clinical need and informed patient choice – and which are not? The important question is how to promote ‘good’ variation and minimise ‘bad’ variation. ...
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 ...
This report reveals that two-thirds of the PCTs responding to the survey had not yet carried out any assessment to identify patients who might need support in making choices about which hospital to go to. A similar proportion had not commissioned any new services to support the introduction of patient ...
This paper, the first in a series of WSDAN briefing papers, looks at how telehealth and telecare innovations are being used in health and social care. It considers the range of innovative approaches that have been developed, giving some practical examples. It identifies some of the key challenges to the ... and WSD Action Network has been commissioned by the Whole System Demonstrator Programme at the Department of Health and through the Department of Health's Policy Research Programme. The Network is hosted by The King's Fund and DH Care Networks on behalf of the Department of Health.
Maternity services – in common with the rest of the NHS – need to focus on new ways of working to maintain and increase levels of safety and quality of care within the resources available. There are particular pressures on maternity services because of the rise in birth rates and ...
The coalition government wants to encourage health care providers to consider employee ownership, and the development of mutuals, with the aim of creating ‘the largest and most vibrant social enterprise sector in the world’ (Department of Health 2010a, p 36). These plans are part of a broader programme of public ...
The impact of funding cuts to the NHS has been widely reported and discussed, but less attention has been given to social care – and, most importantly, to the inter-relationships of health and social care. Social care funding has increased in real terms for the past decade, but there has ...
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 ...
First introduced into health care in the 1980s in the United States, and later developed and championed by Monitor in England as part of its function to support good financial and performance governance in foundation trusts, service-line reporting (SLR) and service-line management (SLM) are one approach to informed clinical leadership ...
The health and social care system is currently tackling three inter-related challenges: coping with rising demand and reduced funding; handling NHS restructuring; and transforming social care. How can these challenges be seen as an opportunity to achieve fundamental change to the system? The Routes project, a simulation exercise created by ... and The Routes project was commissioned by The King’s Fund in partnership with the Joseph Rowntree Foundation, the Social Care Institute for Excellence, the Association of Directors of Adult Social Services and the Local Government Association.
Studies in many industries, including health care, suggest that leadership is a critical element in organisational performance. Collins (2001) suggests that disciplined, hard-working leaders are essential to moving organisations from 'good' to 'great'. Such leaders help companies to recruit the right leadership team, develop an effective strategy and create a ...
General practitioners make over 9 million referrals each year, triggering many billions of pounds of expenditure. There is also significant variation in the quality and rate of referral between GPs and GP practices. As the NHS faces a prospective funding gap of £14-£20 billion and GPs take the lead for ...
The NHS is entering a period of acute financial pressure and needs to find up to £20 billion in productivity improvements over the next few years. There are particular challenges for the many hospital trusts that enter the ‘cold’ financial climate with deficits and legacy debt. Reconfiguring Hospital Services: Lessons ...
This report reviews recent developments in thinking and action in relation to leadership in the public and voluntary sectors, based on published and in press academic literature and in observed practices on the ground. The aim of the report is to stimulate discussion about the implications for leadership for health ...
As part of its work looking at the pressures being faced by the NHS, The King’s Fund published its first Quarterly Monitoring Report in April 2011. This is the fourth report, and it aims to
provide a real-time update on how the NHS is coping as it tackles the evolving ...
The report was commissioned by The King’s Fund on behalf of an independent panel. The views expressed in this report are those of the independent panel and do not necessarily
represent the views of The King’s Fund and In this document, we outline the key findings for professionals in general practice and describe the central role that general practice must now play to improve the quality of health care
This, the second annual King's Fund Lecture at the Faculty of Public Health Medicine annual conference, warns that mental health policy has become obsessed with protecting the public from 'mad axemen' to the detriment of patient care. Jeremy Laurance, health editor at The Independent, states that since the death of ...
This report identifies the key values relevant to public health policy and outlines the potential conflict and synergies between these values. It sets the scene for the 'Public Health and Public Values' project at the King's Fund. The project aims to engage Londoners in a public debate about how public ...
This discussion paper examines psychosocial provision in the community for dying people, and argues that the new-found commissioning powers of primary care trusts (PCTs) are the key to unlocking better, more integrated care. PCTs are now in the position to: strengthen clinical governance within the new N.I.C.E. guidelines; improve education ...
This is one of a series of papers being produced in 2002/03 as part of the King's Fund Mental Health Inquiry. The Inquiry aims to assess whether London mental health and mental health services have improved over the last five years. In 1997 the King's Fund produced a report entitled ... and Effective promotion of mental health and well being encompasses coordinated activities for communities, families and individuals. However, little is known about the current state of mental health and well being promotion in London. This paper seeks to fill that gap, drawing evidence from three 'case study' projects promoting mental health ...
A high proportion of people in the criminal justice system have mental health problems, and often they do not get the support they need. Revolving Doors, a registered charity based in Clerkenwell, runs a scheme in which staff known as link workers provide practical support for people with mental health ...
This paper provides a commentary on the progress being made by the NHS and local government as they work together to improve services for older people and people with long-term illness or disability. The views expressed are those of the King's Fund, drawing on discussions in an expert group convened ...
This report provides an analysis of the NHS management workforce and how it has changed over the past 14 years, using data from the Binley's Database of NHS Management produced by Beechwood House Publishing Ltd. The report has been produced for The King's Fund Commission on Leadership and Management in ...
This working paper aims to revisit findings from the 1997 King's Fund Inquiry on Mental Health and to examine the extent to which primary care mental health services have developed in line with recommendations made at that time. It takes a narrow view of 'primary care' as relating to general ...
The NHS is facing a significant financial challenge and needs to make substantial improvements in productivity if it is to provide high-quality services without additional funding. Spending on mental health accounts for around ten per cent of the overall health budget and so the mental health sector has a key ...
This case study is one of six, which form part of a project undertaken by The King's Fund to investigate the different ways in which consultants are working beyond their traditional boundaries. The King's Fund's staff reviewed relevant documentation and interviewed staff to help identify the key characteristics of this ...
This case study is one of six, which form part of a project undertaken by The King's Fund to investigate the different ways in which consultants are working beyond their traditional boundaries. The King's Fund's staff reviewed relevant documentation and interviewed staff to help identify the key characteristics of this ...
Since their formation in 2012, clinical commissioning groups (CCGs) have already faced formidable challenges, tasked with managing substantial commissioning budgets amid increasing financial pressure. In a further development from 1 April 2015, CCGs will now also be given the option to take up more devolved powers to co-commission primary care ...
This case study is one of six, which form part of a project undertaken by The King's Fund to investigate the different ways in which consultants are working beyond their traditional boundaries. The King's Fund's staff reviewed relevant documentation and interviewed staff to help identify the key characteristics of this ...
This case study is one of six, which form part of a project undertaken by The King's Fund to investigate the different ways in which consultants are working beyond their traditional boundaries. The King's Fund's staff reviewed relevant documentation and interviewed staff to help identify the key characteristics of this ...
This case study is one of six, which form part of a project undertaken by The King's Fund to investigate the different ways in which consultants are working beyond their traditional boundaries. The King's Fund's staff reviewed relevant documentation and interviewed staff to help identify the key characteristics of this ...
This case study is one of six, which form part of a project undertaken by The King's Fund to investigate the different ways in which consultants are working beyond their traditional boundaries. The King's Fund's staff reviewed relevant documentation and interviewed staff to help identify the key characteristics of this ...
Free registration required to access this tool. and This assessment tool was developed in collaboration with NHS trusts participating in The King’s Fund’s Enhancing the Healing Environment (EHE) programme. This phase of the EHE programme was funded by the Department of Health to support the implementation of the National Dementia Strategy. The assessment tool is informed by research ...
These slides are based on 'The district council contribution to public health: a time of challenge and opportunity', an independent report written by The King's Fund but commissioned by District Councils' Network. and In partnership with District Councils' Network, we have produced a set of slides that illustrate the key role played by district councils in keeping us healthy. We hope they will be a useful resource for you - please feel free to use them in your office, in documents or presentations.
This slideshow presents the key findings from a survey of GPs in six clinical commissioning groups (CCGs). The survey was conducted by the Nuffield Trust and The King’s Fund as part of a three year project, looking to understand how the clinical commissioning groups at the heart of the NHS ...
This slide deck presents the fourth and final year of results from an annual survey of GPs and practice managers in six CCGs across the country. The survey explores how GP attitudes towards clinical commissioning have evolved since their launch in 2013. The results show that over the past three ...
The government wants shared decision-making to become the norm in the NHS, but there is confusion about why it is important, what it involves and what the implications might be for patients, clinicians and the wider health service. This report clarifies the concept and outlines the actions needed to make ...
The National Health Service (NHS) is facing one of the toughest financial periods of its history during which it will need to maintain the quality of care. Clinical leadership will be critical as the service faces this challenge. The King's Fund has a wealth of experience in developing the skills ...
This publication describes projects in 19 NHS trusts and one HM prison that took part in schemes to improve the environment of care at the end of life. It describes the broader Enhancing the Healing Environment programme, which has been supported by the Department of Health in a series of ...
The coalition government has made clear its commitment to the integration of health and social care in its proposals for reform. In the context of the intense financial and demographic challenges facing both health and social care, this paper offers a fresh assessment of the prospects for integrating health and ...
Integration of health and social care is a core policy aim of the new coalition government in England. It has several benefits for patients, particularly older people and those with long-term conditions. But how does integration work in practice? This paper sets out how one particular area – Torbay – ...
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 report was commissioned by The King’s Fund on behalf of an independent panel. The views expressed in this report are those of the independent panel and do not necessarily
represent the views of The King’s Fund and General practice is often regarded as the bedrock of the English health care system. Surveys consistently report high levels of trust in GPs and good levels of patient satisfaction with the services they receive in general practice. However, other than data available through the Quality Outcomes Framework and the GP ...
When it came to power in 1997 the Labour government committed to reducing health inequalities, and made extra funding available to those primary care trusts (PCTs) in areas of the country with the worst health and deprivation indicators (Spearhead areas). The General Medical Services contract introduced a pay-for-performance scheme known ...
Cancer survival rates in England are improving, but they still lag behind those in the best-performing countries in the world. The current government has identified cancer survival rates as an area for improvement and the cancer strategy commits to saving an additional 5,000 lives by 2015, but how can these ...
As part of its work on the pressures faced by the NHS, The King’s Fund published its first Quarterly Monitoring Report in April this year. This is the third report and it aims to provide a
regular update on how the NHS is coping as it tackles the evolving reform ...
Many NHS hospitals will struggle to deliver productivity improvements essential to maintaining quality and avoiding significant cuts to services, according to our latest quarterly monitoring report. This is the second quarterly monitoring report produced by the Fund as we aim to provide a regular update on how the NHS is ...
Over the next few years the NHS faces two unprecedented challenges: coping with the tightest funding settlement for decades and implementing top-to-bottom reforms of the system. The broad goal of both the productivity and reform challenges is to improve NHS performance and hence the quality of patient care. But both ...
This guide sets out some basic facts on the health of England's population, including the main drivers of health, how it varies and is expressed in inequalities, and relevant comparisons with other countries.
Quality accounts are a key mechanism through which health care organisations can demonstrate their focus on improving the quality of their service. The government has recently undertaken an evaluation of the 2009/10 quality accounts and set out their expectations for 2010/11. The King’s Fund undertook an independent analysis of a ...
This publication is a summary of a full length study of how the news media cover health issues. It tests the premise that television news programmes and newspaper stories distort perceptions of risk to health by under reporting serious public health issues that kill many people, such as obesity and ...
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 ...
An independent NHS board has been advocated by a number of commentators, who believe it will reduce both micromanagement and day-to-day political interference in the running of the health service. This report argues that an independent board would be limited in its ability to achieve these aims. It suggests a ...
Written for the NAPC and KPMG, this introductory guide to good governance for clinical commissioning groups aims to help them take their first steps towards authorisation.
This summary contains the findings, conclusions and recommendations of the King's Fund Care and Support Inquiry into the quality of services for people needing care and support. The inquiry was commissioned to examine whether the government's reforms of care service regulation would produce meaningful results and to explore which additional ...
At a time of enormous change in the NHS, leaders and managers have a crucial role to play. But what sort of leaders does the service need? Does the model, prevalent in public service over recent years, of the ‘hero’ chief executive still hold sway? The King’s Fund set up ...
Bringing together the findings from the Caring Choices events and website, this report looks at possible solutions to the problem of funding long-term care. Caring Choices, a coalition of 15 organisations from across the long-term care system, aimed to raise awareness and encourage debate, as well as generate and test ...
This review of followership in the NHS begins with a brief review of the clamour for leadership in the recent past as a way of transcending the apparent failure of the prior governance and targets approach. It suggests that to focus upon leadership, and a particular form of leadership, is ...
The government's recent announcement to introduce a new funding model for adult social care, based on the recommendations of the Dilnot Commission, is the latest
development in the long history of many attempts to review the way in which social care is funded and how the costs of these services ...
This paper aims to help those planning and implementing major clinical service reconfigurations ensure that change is as evidence-based as possible. It investigates the five key drivers – quality, workforce, cost, access and technology – across 13 clinical service areas, and summarises the research evidence and professional guidance available in ...
Chronic medical conditions such as asthma, diabetes, heart failure and hypertension affect large numbers of people, including patients, carers, families and friends. As the population in England ages, growing numbers of patients will need help with managing complex, multiple conditions over sustained periods. Apart from the burden of ill-health, treating ...
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 ...
The King’s Fund’s Time to Think Differently programme of work aims to stimulate debate about the changes needed for health and social care to meet the challenges of the future. It aims to generate new thinking about how to address these challenges and deliver a transformation in services for patients. ...
This paper aims to probe what it sees as a woefully under-explored area: the differences between the United Kingdom's four separate health systems. These systems, it argues, are diverging in terms of structures, management approaches, and the way social care relates to health.
NHS and voluntary sector providers have a key role to play in delivering the priorities set out in the NHS Mandate, alongside commissioners and others in the wider health and care system. This report, commissioned by the Foundation Trust Network (FTN) and the Association of Chief Executives of Voluntary Organisations ...
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 ...
The NHS workforce is the primary driver of future health costs. Given the substantial changes in population demographics and health care needs, the workforce needs to be fit for purpose. That means responding to immediate needs and financial pressures while adapting to deliver the future care models outlined in the ...
The NHS has undergone many reforms over the past decade. To test out where the reforms - and interactions between them - might lead the NHS, the King's Fund formed a partnership with Loop2, Monitor and Nuffield Hospitals to produce Windmill 2007. This initiative included a two-day simulation of a ...
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 ...
Patient choice has been central to the government's recent NHS reforms, along with a new payment system that rewards hospitals that are attractive to patients. But will these reforms make services more responsive? In the treatment of HIV and AIDS, patients have always had a choice of which hospital to ...
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 November and December 2012, The King’s Fund and the Nuffield Trust held a series of events in Parliament, to look beyond recent reforms and discuss the next wave of challenges facing the health and social care system.
This Viewpoint features personal reflections by eight of the parliamentarian speakers, based ...
The King’s Fund was commissioned by Oxleas NHS Foundation Trust to work with their quality board to facilitate an assessment of its existing approaches to quality improvement and to develop a strategy for future work. This case study details the approach and philosophy behind this work, which involved working with ...
This report considers the role and value of volunteers in health and social care. It looks at the important part that volunteers play in improving patient experience, addressing health inequalities, and building a closer relationship between services and communities.
This report summarises the main findings of a project designed by the King's Fund to engage Londoners in a public debate around controversial issues arising from current public health strategies in the capital. The aims of the project were to: identify the means of eliciting values in a public debate; ...
Patient feedback is an important tool for tracking the experience of those who use NHS services and, through this, the quality of care they receive. It also plays a key role in identifying problem areas and shaping service improvements. Maternity services are using a variety of feedback mechanisms, in addition ...
Most formal care services for older people are funded by the public sector, but they are largely supplied by independent providers. This paper looks at what factors influence the 'mixed economy' of the care market, including what funding is available and from where, and how commissioning works, and the role ...
Increasing demands on general practice over the past five years - not just a heavier workload but the increasing complexity and intensity of work - have led to a feeling of crisis. The NHS is finding it difficult to recruit and retain sufficient GPs who want to do full-time, patient-facing ... and This report is accompanied by 'A day in the life of a GP'. This typical day in the life of a GP draws on the experiences of several GPs working in different practices who we spoke to as part of the research for this report. It has been reviewed by ...
This report summarises the discussions of 11 consultation events, ‘21st Century Doctor: Your future, your choices’, run from October 2009 to April 2010. An earlier series of events, ‘Do Doctors Have a Future?’ ran from May 2006 to April 2007
and looked at the way that doctors viewed the challenges ... and Acquiring and ensuring a professional approach is a key part of becoming a doctor. But how can doctors define and adopt this professional attitude and ensure that it is kept up to date in the same way as their clinical skills? And how should professionalism adapt and change to reflect ...
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 ...
The government’s mandate for achieving parity of esteem between physical and mental health has put the spotlight on mental health provision. In London, meeting the mental health needs of the large and diverse population poses major challenges, and the London Health Board has identified improving the mental wellbeing of Londoners ...
Marcus Powell joined The King’s Fund in 2016 as Director of Leadership and Organisational Development, having spent his whole career outside the NHS in the private sector. This paper contains his initial observations about leadership in the NHS.
The aim of this discussion paper is to give the reader an understanding of the issues involved in rationing in the evolving context of the contemporary NHS in England. Our paper is not intended as a primer: we provide no advice about how rationing decisions ought to be made. Nor ...
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 ...
This report, the second part of 'The NHS under the coalition government', looks at how well the NHS has performed under the coalition government. The report acknowledges that assessing the performance of any health service is an inexact science for many reasons, but using routinely available data, the report creates ...
The unprecedented slowdown in the growth of NHS funding in England since 2010 has meant that the NHS has had to pursue the most ambitious programme of productivity improvement since its foundation in order to close the gap between need and available funding.
This report describes how six trusts have been ...
The general election will come at a pivotal time for health and social care. An unprecedented funding squeeze has left the NHS on the brink of financial crisis, while reductions in local government funding have led to significant cuts in social care services.
This report, published in partnership with NHS Providers, draws on the views and experiences of twelve departed or departing chief executives, or those changing jobs within health care. It aims to illuminate the realities of leadership in today’s NHS. The interviews illustrate both the positives of the job and its ...
In November 2011, The King’s Fund invited academics, practitioners, policy-makers and representatives from patient and voluntary organisations to discuss the care of very old frail people with complex health problems. Mindful of the work of others (NHS Confederation, the Local Government Association and Age UK 2012; The Mid Staffordshire NHS ...
In light of the high number of board-level vacancies in the NHS and an increasing reliance on expensive locum and agency staff, NHS organisations need to have effective strategies in place to develop future leaders. This paper helps boards and other NHS leaders to decide which processes and systems need ...
This paper seeks to identify the skills, knowledge and behaviours required of new system leaders and to learn from systems attempting to combine strong organisational leadership with collaborative system-level leadership approaches. The paper draws on three years' development work with leaders in health care systems in north-west England, undertaken by ...
This report draws on the experiences of ten senior leaders to look in depth at the skills needed to be a system leader. The ten individuals are from different backgrounds and work in different contexts, and give some very candid reflections on their successes and failures. There was consensus among ...