NHS key moments

Important events in modern UK healthcare history

Many recent events have shaped changes in process that may be relevant to the way departments work:

• 1983—Griffiths report: the introduction of general management
  • enshrines the general management function, removing the consensus management system that is widely regarded as having failed. This leads to a major increase in managers’ pay.
• 1989 Working for patients: “the internal market” (NHS reforms)
  •  proposed to introduce a split between purchasers and providers of care, GP fundholders and a state-financed internal market, in order to drive service efficiency.
• 1997 White paper – The New NHS, Modern, Dependable.
  • NICE evolved perhaps primarily after failings in the NHS breast screening service.
  • The National Institute for (Health and – later added) Care Excellence (NICE) is an executive non-departmental public body of the Department of Health
    • publishes guidelines in four areas:
      • the use of health technologies – new and existing medicines, treatments and procedures,
      • clinical practice guidance
      • guidance on health promotion and ill-health avoidance
      • guidance for social care services and users.
• 1999 To err is human: building a safer healthcare system (Kohn et al)
  • asserts that the problem is not bad people in health care–it is that good people are working in bad systems that need to be made safer.
  • clear prescription for raising the level of patient safety in American health care
• 2000 The NHS Plan: A Plan for Investment, a Plan for Reform
  • key financial features, new contracts, and patient information and empowerment (including NHS Direct and patient advice and liaison services), performance targets (including the monitoring bodies the Commission for Health Improvement, Healthcare Commission)
• 2001 Health and social care act
  • intended to deliver  the NHS Plan and also was the Government’s response to the Royal Commission on Long Term Care, requiring changes to primary legislation. Its purpose was to improve the performance of the NHS.
• 2005 Tooke report
  • Modernising medical careers. Introduction of FY1/2 and run-through training, and the design of the CCT. Run by MTAS. Multiple problems with technical side of the applications system, numbers of posts and ‘fairness’ of the scoring system. Many senior figures resigned.
• 2008 Darzi report
  • ‘High quality care for all” – concludes a series of reports, consultations and recommendations for a ten year vision for a world class (NHS) that is fair, personal, effective and safe.
  • extensive consultation with 60,000 staff, patients and stakeholder groups (including 2,000 clinicians)
  • published alongside two other documents:
    • A consultation on the NHS constitution (core principles and values of the NHS) – pledges and promises to the public.
    • A high quality workforce: NHS Next Stage Review – defines how NHS, higher education sector and industry can work together to improve the quality of training in the NHS
• 2008 Health and social care act.
  • Healthcare Commission, Commission for Social Care Inspection and  Mental Health Act Commission combined to form Care Quality Commission. To regulate:
  • provision of health care to patients (NHS or foundation trust)
  • provision of ambulance services
  • provision of health care to patients by a Primary Care Trust.
  • management of NHS Blood and Transplant
  • Inception of NHS improvement

• 2010 Kennedy report
  • Overcoming cultural barriers in the NHS so as to meet their needs – a response to the BRI paediatric cardiac surgery investigation findings.
• 2010 White paper Equity and Excellence: Liberating the NHS
  • Putting patients and the public first
  •  ‘shared-decision making’
    • ‘an information revolution’ for patients. Openness about options and errors
    • Patient-reported outcome measures (PROMS) and patient experience surveys.
    • increased choice – named consultant
    • National consumer organisation – HealthWatch England (within Care Quality Commisision) .Local HealthWatch bodies.
  • Improving health care outcomes, hence NHS Outcomes Framework; national outcome goals determined by the Secretary of State;
    1. Preventing  dying prematurely
    2. Enhancing quality of life for people with long term conditions
    3. Helping people to recover from episodes of ill health
    4. Ensuring a positive experience of care
    5. Treating and caring for people in a safe environment, avoiding harm
• 2012 Health and social care act
  • giving groups of GP practices and other professionals – clinical commissioning groups (CCGs) – ‘real’ budgets to buy care on behalf of their local communities;
    • GP practices as the members;
    • Led by an elected governing body made up of GPs,  nurse, secondary care consultant, lay members;
    • Responsible for approximately 2/3 of the total NHS England budget
    • Responsible for commissioning healthcare including mental health services, urgent and emergency care, elective hospital services, and community care;
    • Independent, and accountable to the Secretary of State for Health and Social Care through NHS England;
    • Now supported by Commissioning support units (CSU) for contracting, budget management etc.
  • shifting many of the responsibilities historically located in the Department of Health to a new, politically independent NHS Commissioning Board (this has now been renamed NHS England);
  • the creation of a health specific economic regulator (Monitor), mainly for foundation trusts, with a mandate to guard against ‘anti-competitive’ practices; and
  • moving all NHS trusts to foundation trust status.
• 2013 Francis report
  • A response to the Mid-Staffordshire hospital mortality failings.
    •  priotitise standards of care of vulnerable older patients
    • Care Quality Commission to lead on developing standards with participation from patients, health care staff etc.
    • using NHS recruitment/induction/appraisal promote the values of the NHS Constitution.
    • clarifying the regulatory arrangements for health providers
    • prioritise routinely collected, real-time data to  measure quality.

• 2014 5 year forward view
  • Multisepcialty community providers – GPs come into groups with other health and social care providers re out-of-hospital care
  • Primary and acute care systems – single group of providers to provide community, MH and hospital services for the locale.
  • Urgent and emergency care networks – to be simplified and integrated
  • Acute care collaborations (ACC) – linking of hospital services for care and financial stability.
  • Specialized care – focus on specialist centres, where the evidence recommends this.
  • Modern maternity services – new model to be developed
  • Enhanced health in care homes – integration of care home providers and local authorities.
• 2016 Streamlining NHS (not a formal term!)
  • Monitor, NHS Trust Development Authority, Patient Safety, National Reporting and Learning System, Advancing Change Team and Intensive Support Teams all combine to form NHS Improvement.
  • NHS improvement, although keeping some identity, merged with NHS England in 2018.
  • Get it right first time (GiRFT) – to reduce the variation in practice a number of workstream leads have been setup to start a process of data collection (datasets from visits to trusts), revisiting to re-run the dataset, objective setting and then provision of support for each site.
• 2016 NHSIQ White Paper – The new era of thinking and practice in change and transformation
  • several questions about organisational and system change, including:
  • Who does it (many change agents, not just a few)
  • Where it happens (increasingly ‘at the edge’ of organisations and systems)
  • The skills and mindsets that change agents need
• The paper also includes four case studies:
  1. Living Well in Cornwall and the Isles of Scilly – Striving for a collective humility in finding a way to work together for the person’s benefit
  2. A grass-roots movement sparked by students coming together to prevent avoidable pressure ulcers
  3. The NHS Change Day ‘hubbies’: a voluntary self-organising network of local leaders
  4. The School for Health and Care Radicals – teaching change agents to rock the boat and stay in it

NHS structure – a brief slideset

GMC good medical practice

AOMRC – NHS finance

CRES, budgets, service redesign

New ways of working

Revalidation/Shipman