A report on the future of public health said that there should be no individual 'right to health' enshrined in law - public health policy should take a risk-based approach; that devolution should provide the basis for any future public health reforms; that a new United Kingdom-wide Public Health Commission could provide health ministers in England, Scotland, Wales and Northern Ireland with up-to-date advice and guidance based on the experience of other countries, but it should not have enforcement powers; that reform of public health legislation needed to be undertaken as a government priority, but not in a single all-encompassing Act; and that the Department of Health should increasingly focus on public health matters rather than on National Health Service management.
Source: Towards a Reformed Public Health System, Royal Society for the Promotion of Health (020 7630 0121)
Links: Report (pdf) | RSPH press release
Date: 2003-Dec
A report described recent health trends in England, and set the context of an ongoing review by Derek Wanless into National Health Service funding. It identified poor lifestyles among low-income groups as a root cause of health inequalities. (In April 2003 Derek Wanless was asked by the government to examine how public health spending decisions were taken, and how to ensure that they could be taken as cost-effectively and consistently as possible, in order to improve health outcomes for any given level of resources. This included an assessment of the evidence about what interventions worked.)
Source: Derek Wanless, Securing Good Health for the Whole Population: Population health trends, HM Treasury (020 7270 4558)
Links: Report (pdf) | HMT press release | Guardian report
Date: 2003-Dec
The Welsh Assembly Government announced new health targets for older people. The targets were to reduce deaths from stroke by 20 per cent in the 65-74 age group by 2012; reduce hip fractures by 10 per cent in the 75-plus age group by 2012; increase moderate to vigorous exercise behaviour in the 50-64 age group; and narrow the gap between the most deprived and least deprived groups.
Source: Press release 20 November 2003, Welsh Assembly Government (029 2082 5111)
Links: WAG press release
Date: 2003-Nov
The Health and Social Care (Community Health and Standards) Act received Royal assent, following an initial defeat in the House of Lords and a revolt by backbench MPs. It provided for the introduction of quasi-autonomous 'foundation trusts' within the National Health Service.
Source: Health and Social Care (Community Health and Standards) Act, TSO (0870 600 5522)
Links: Text of Act | DH press release | Guardian report (1) | Guardian report (2)
Date: 2003-Nov
Family doctors said that improving patients' choice over the healthcare decisions affecting them depended more on a strong patient-doctor relationship than on changes to financial relationships within the National Health Service structure.
Source: Response to Consultation: 'Payment by Results', British Medical Association (020 7383 6244)
Links: Response | BMA press release | Consultation document (pdf)
Date: 2003-Nov
A report said that the government would not meet its objectives in areas such as heart disease, mental health and suicide, smoking or sexual health unless it adopted different health strategies and targets for women and men.
Source: Lesley Doyal, Sarah Payne and Ailsa Cameron, Promoting Gender Equality in Health, Equal Opportunities Commission (0161 833 9244)
Links: Report (pdf) | EOC press release
Date: 2003-Nov
A report evaluated reforms to the National Health Service since 1997. It said that, with the increased financial commitment and the quality reforms in place, it was reasonable to expect that the NHS would continue to show significant progress in meeting the health needs of patients. But it criticised political interference and an obsession with targets.
Source: Sheila Leatherman and Kim Sutherland, The Quest for Quality in the NHS: Mid-term evaluation of the ten-year quality agenda, Nuffield Trust, TSO (0870 600 5522)
Links: Nuffield Trust press release (Word file) | Guardian report (1) | Guardian report (2)
Date: 2003-Nov
An article argued that the introduction of foundation trusts in the National Health Service risked widening inequalities. Safeguards to ensure that equal care was available to everyone who needed it were described as 'insufficient': there were no duties on either foundation trusts or the independent regulator to safeguard the principles of universality and equity. Moreover, it would be the independent regulator, and not local people, who would be responsible for deciding which services were provided where and how.
Source: Allyson Pollock, David Price, Alison Talbot-Smith and John Mohan, 'NHS and the Health and Social Care Bill: end of Bevan's vision?', British Medical Journal 25 October 2003
Links: Article | BMJ press release | Care and Health report
Date: 2003-Oct
The opposition Conservative party proposed a patients passport' plan, which it said would cut waiting lists and stop people having to use their savings for operations. Under the proposals, anyone choosing to have treatment privately could be subsidised by up to 60 per cent of the cost of having it done on the National Health Service.
Source: Press release 6 October 2003, Conservative Party (020 7222 9000)
Links: Conservative Party press release | Speech | Guardian report
Date: 2003-Oct
A discussion paper said a new statutory body should be created, with responsibility for setting 'realistic' targets for improving the National Health Service and then delivering them. Government would then be able to focus on developing wider health policy instead of meddling in healthcare services on a day-today basis.
Source: Steve Dewar, Government and the NHS: Time for a new relationship?, King s Fund (020 7307 2591)
Links: Paper (pdf) | KF press release | Guardian report
Date: 2003-Oct
The Health Secretary published a pamphlet arguing that a National Health Service driven from Whitehall had neither delivered equality nor fulfilled its full potential. He called for a more localised NHS - locally driven, locally responsive and locally accountable. But at the launch event he reportedly admitted that locally controlled foundation hospitals were an experiment, and that he had no clear idea how the project would work out in practice.
Source: John Reid MP, Localising the National Health Service: Gaining greater equity through localism and diversity, New Health Network (020 7407 1618) | The Guardian, 25 September 2003
Links: Summary | Guardian report
Date: 2003-Sep
A new book provided a comprehensive and up-to-date study of health policy and health services development in Scotland over the previous twenty years. It said that since 1997 the new Labour government had sought a third way based on partnership , and during this period networks had emerged as a preferred organisational model: but in reality there were no clear-cut points of change.
Source: Kevin Woods and David Carter (eds.), Scotland s Health & Health Services, Nuffield Trust, TSO (0870 600 5522)
Links: Nuffield Trust press release (Word file)
Date: 2003-Sep
A report said that news coverage of health issues was seriously out of proportion to actual risks to health. The news agendas of the print and broadcast media were skewed heavily towards dramatic stories such as crises in the National Health Service and major health scares , rather than issues that statistically had a greater impact on health, such as smoking, obesity, mental health and alcohol misuse. (Researchers compared the volume of reporting on specific health risks with the number of deaths attributed to those risks.)
Source: Roger Harrabin, Anna Coote and Jessica Allen, Health in the News: Risk, reporting and media influence, King s Fund (020 7307 2591)
Links: Summary (pdf) | KF press release | Guardian report
Date: 2003-Sep
A paper argued that the establishment of foundation hospitals was being pursued for largely pragmatic and electoral reasons, with the attendant (but not publicly acknowledged) risk of fragmenting and dividing the service, and of reproducing features which the supervisory and regulatory state of the 1930s was unable to deal with satisfactorily.
Source: John Mohan, The Past and Future of the NHS: New Labour and foundation hospitals, History & Policy website (web publication only)
Links: Paper
Date: 2003-Sep
A paper examined whether competition within the National Health Service in the 1990s (the 'internal market') had led to better outcomes for patients, as measured by death rates after treatment following heart attacks. It was found that the relationship between competition and quality of care appeared to be negative.
Source: Simon Burgess, Denise Gossage and Carol Propper, Competition and Quality: Evidence from the NHS internal market 1991-1999, Working Paper 03/077, Centre for Market and Public Organisation/University of Bristol (0117 954 6943)
Links: Paper (pdf)
Date: 2003-Aug
The government began a consultation exercise to look at ways in which the delivery of health and social care could offer more choice, become more responsive to patients, and also tackle inequalities - with the aim of making sure that everyone had good access to high quality health and social care.
Source: Fair for All: Personal to You - Choice, responsiveness and equity in the NHS and social care, Department of Health (08701 555455)
Links: Link to document removed by DH | NHS press release
Date: 2003-Aug
The government said that, by December 2005, all National Health Service patients in England would be given a choice of at least four hospitals for any treatment recommended by a family doctor.
Source: Speech 15.7.03 by John Reid MP (Secretary of State for Health) | Choice of Hospital: Guidance for PCTs, NHS Trusts and SHAs on offering patients choice where they are treated, Department of Health (08701 555455)
Links: Text of speech | DH press release | Guardian report
Date: 2003-Jul
The Health and Social Care (Community Standards) Bill was given a third reading. An amendment to remove foundation trust proposals from the Bill was defeated by just 286 votes to 251, following a revolt by backbench Labour MPs.
Source: House of Commons Hansard, Debate 8.7.03, columns 916-1099, TSO (0870 600 5522) | Health and Social Care (Community Health and Standards) Bill, Department of Health, TSO
Links: Hansard | Text of Bill | Guardian report
Date: 2003-Jul
A paper argued that a series of proposed safeguards on foundation trusts (designed to protect the fundamental goals and principles of the National Health Service) were inadequate. It urged the government to withdraw the part of the Bill creating the trusts, in order that better public health safeguards could be devised.
Source: Allyson Pollock and David Price, In Place of Bevan?: Briefing on the Health and Social Care (Community Health and Standards) Bill 2003, Catalyst, Society for Social Medicine, and NHS Consultants Association, available from Central Books (020 8986 4854)
Links: Paper (pdf)
Date: 2003-Jul
An independent review found that the health of people in Wales was relatively poor; that the configuration of health services placed an insupportable burden on the acute sector and its workforce; and that Wales did not get as much out of its health spending as it should. The report recommended a much greater emphasis on preventing ill health; greater efforts to break down barriers between health and social care; and an end to the underwriting of National Health Service deficits each year by the Welsh Assembly Government.
Source: The Review of Health and Social Care in Wales: Report of the Project Team advised by Derek Wanless, Welsh Assembly Government (029 2082 5111)
Links: Report (pdf) | Summary (pdf) | WAG press release | Community Care article (1) | Community Care article (2)
Date: 2003-Jul
The government published its response to a report by MPs into proposed 'foundation trusts'. It said that creation of the trusts was a key step in its reform strategy of giving greater freedoms to National Health Service organisations, moving to a system of local delivery and accountability, and giving patients greater diversity of provision and more choice.
Source: Government Response to the Health Committee's Second Report of Session 2002-03 into NHS Foundation Trusts, Cm 5876, Department of Health, TSO (0870 600 5522)
Links: Response (pdf) | MPs' report
Date: 2003-Jul
A senior government health advisor (director of the Health Department strategy unit) warned that plans for reforming the National Health Service depended on 'clinical leadership' - involving doctors and other medical professionals in organisational change - rather than simply on ambitious blueprints.
Source: Chris Ham, 'Improving the performance of health services: the role of clinical leadership', The Lancet 6.6.03 (020 7424 4910)
Links: Summary
Date: 2003-Jun
The opposition Conservative Party published a consultation paper on reform of the National Health Service. It proposed a 'patient passport' which would entitle holders to state-subsidised private health care.
Source: Setting Patients Free, Conservative Party (020 7222 9000)
Links: Report (pdf) | Conservative Party press release | Liam Fox speech
Date: 2003-Jun
The Scottish Executive published a Bill designed to 'modernise' the National Health Service structure in Scotland. NHS trusts would be abolished; new community health partnerships would be established; and there would be a duty on health boards to involve the public more closely in planning, developing and operating healthcare services.
Source: National Health Service Reform (Scotland) Bill, Scottish Executive, TSO (0870 606 5566)
Links: Bill (pdf) | SE press release
Date: 2003-Jun
A think-tank briefing paper said that quasi-independent foundation trusts proposed for the National Health Service had the potential to deliver real improvements in performance, but that careful piloting and independent evaluation would be needed.
Source: Health and Social Care (Community Standards) Bill: Second Reading Briefing, King s Fund (020 7307 2591)
Links: KF paper (pdf) | KF press release
Date: 2003-May
The Health and Social Care (Community Standards) Bill was given a second reading. Up to 63 Labour MPs refused to support it, despite government promises that it would spend 200 million to help raise standards in the poorest performing hospitals, and that all hospitals in England would be able to apply for foundation status by 2008. The House of Commons Library produced two background briefing papers on healthcare aspects of the Bill: one examined foundation trusts, while the other examined other healthcare proposals in the Bill (including the proposed creation of a Commission for Healthcare Audit and Inspection).
Source: House of Commons Hansard, Debate 7.5.03, columns 696-808, TSO (0870 600 5522) | NHS Foundation Trusts in the Health and Social Care (Community Health and Standards) Bill, Research Paper 03/38, House of Commons Library (web publication only) | The Health and Social Care (Community Health and Standards) Bill: Health aspects other than NHS Foundation Trusts, Research Paper 03/41, House of Commons Library (web publication only)
Links: Hansard | HOC Library research paper 38 (pdf) | HOC Library research paper 41 (pdf) | Text of Bill | Guardian report | Observer (article by Prime Minister)
Date: 2003-May
The Labour Party published a consultation document on health and social care policies. It said that a 'centrally run, one-size-fits-all approach is no longer the most appropriate way to get the best out of a National Health Service that employs over a million people'.
Source: Improving Health and Social Care, Labour Party (08705 900200)
Links: Consultation document (pdf)
Date: 2003-May
A committee of MPs expressed concern that plans for quasi-independent foundation trusts in the National Health Service included direct accountability to four separate types of organisation, in addition to the increased complexities of new contracting arrangements; and that the trusts might therefore be encumbered by more bureaucracy than their predecessors. It also said the proposed system had no minimum standards for patient and public involvement, and there were no coherent guidelines to ensure an equal opportunity for involvement throughout the country.
Source: Foundation Trusts, Second Report (Session 2002-03), HC 395-I, House of Commons Health Select Committee, TSO (0870 600 5522)
Links: Report | NHS Confederation press release
Date: 2003-May
The Scottish Executive published details of a Bill to reform the National Health Service in Scotland. NHS trusts would be abolished, with the aim of cutting bureaucracy and inefficiency by establishing single local health systems. 'Community health partnerships' would be established, which would devolve management responsibility to frontline services. A new duty would be placed on Health Boards and Special Health Boards to ensure public involvement in the health service.
Source: Press release 28.5.03, Scottish Executive (0131 556 8400)
Links: Press release
Date: 2003-May
A think-tank report defended the proposed introduction of quasi-independent foundation trusts in the National Health Service. It said that fears about the creation of a two-tier service were misplaced, and that the trusts would help deprived communities most. It argued for the reforms to be taken further, and for foundation status to be extended to primary care trusts.
Source: Nick Bosanquet and Daniel Kruger, Strong Foundations: Building on NHS reforms, Centre for Policy Studies (020 7222 4488)
Links: Report (pdf)
Date: 2003-May
A think-tank report said that action needed to be taken in four key areas if foundation hospitals were to succeed. The dominance of the acute hospital sector had to be prevented; borrowing from the private sector should not be permitted; the ability of foundation hospitals to set their own pay and conditions should be restricted; and foundation hospitals should be given real freedoms that matched ministerial rhetoric.
Source: Paul Maltby, In the Public Interest? Assessing the potential of public interest companies, Institute for Public Policy Research, available from Central Books (0845 458 9911)
Links: Press release | Summary
Date: 2003-Apr
The 2003 Budget report set out limits on the scope of proposed National Health Service foundation trusts. It said that freedoms granted to the trusts must be 'balanced against the need to prevent any perverse incentives to expand private provision or undermine investment in NHS capacity'. It also said that the associated legislation would safeguard the government's 'absolute commitment' to NHS care continuing to be free at the point of use.
Source: Budget 2003: Building a Britain of economic strength and social justice - Economic and Fiscal Strategy Report, and Financial Statement and Budget Report, HC 500, TSO (0870 600 5522)
Links: Budget report
Date: 2003-Apr
The Secretary of State for Health argued that it was necessary 'to move on from the one-size-fits-all, take-it-or-leave-it, top down health service of the 1940s towards an NHS which embraces devolution, diversity and choice'.
Source: Speech by Alan Milburn MP (Secretary of State for Health), 30.4.03, Department of Health (020 7210 4850)
Links: Text of speech | Guardian report
Date: 2003-Apr
A paper argued that the introduction of foundation hospitals risks undermining an efficient, integrated and equitable National Health Service. It warned that significant distortions and inequities may be created in the allocation of investment, revenues and trained staff; that superficial structures of local accountability and mutualism will do little to restrain the powerful dynamics of competition and commercialisation that will be unleashed; and that the new regulatory regime may entrench the role of private sector provision in some areas and increase the scope for user charges.
Source: John Mohan, Reconciling Equity and Choice?: Foundation hospitals and the future of the NHS, Catalyst, available from Central Books (020 8986 4854)
Links: Report (pdf) | Summary | Press release
Date: 2003-Mar
The Scottish Executive published a framework for progress in four priority areas of health: stressing the importance of infant and child health to later life; helping young people to make healthy choices; engaging employers in improving health at work; and new 'community planning partnerships' bringing together health services, local authorities and voluntary organisations at local level.
Source: Improving Health in Scotland: The challenge, Scottish Executive, TSO (0870 606 5566)
Links: Report (pdf) | Report | Press release
Date: 2003-Mar
The opposition Conservative Party published a discussion document on health policy. It called for all National Health Service acute hospitals to be given foundation status, for the abolition of centrally set targets, and for deep cuts in 'bureaucracy'.
Source: Setting the NHS Free, Conservative Party (020 7222 9000)
Links: Report (pdf) | Press release | Foreword | Guardian report
Date: 2003-Mar
A Bill was published setting out the terms under which National Health Service 'foundation trusts' will operate, including proposals for an independent regulator. The government said its aim was to remove central control over local hospitals, within a framework of national standards. Other measures in the Bill included the establishment of two new independent commissions - the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection - to oversee standards in health and social care respectively. There would be limits (for the first time) on the use of NHS facilities for private practice.
Source: Health and Social Care (Community Health and Standards) Bill, Department of Health, TSO (0870 600 5522)
Links: Text of Bill | DH press release | NHS Confederation press release | Community Care article | Guardian report (1) | Guardian report (2)
Date: 2003-Mar
A think-tank pamphlet argued that the National Health Service is suffering from too many managers, and that extra funding would be wasted on bureaucracy. NHS managers disputed the claims.
Source: Maurice Slevin, Resuscitating the NHS: A Consultant's View, Centre for Policy Studies (020 7222 4488) | Press release 3.2.03, NHS Confederation (020 7959 7272)
Links: Pamphlet (pdf) | CPS press release | NHS Confed press release
Date: 2003-Feb
A think-tank report recommended a radical set of evolutionary changes to the delivery of healthcare. Four main options were identified. The simplest would involve reform of primary care trusts, permitting individuals to choose another PCT if dissatisfied. Other possibilities included a 'treatment voucher' and social insurance along Swiss lines. The most radical would give everyone the chance to become 'mutual members' of the National Health Service, thereby opting to be net contributors and taking responsibility both for themselves and less fortunate members of society.
Source: Health Policy Consensus Group, Step by Step Reform, Civitas (020 7401 5470)
Links: Report (pdf) | Summary (pdf) | Press release
Date: 2003-Feb
The Scottish Executive published a White Paper on the future of the National Health Service in Scotland, describing it as 'a blueprint to transform Scotland s health and its health services'. NHS trusts would be abolished, and there would be a new guarantee on treatment time.
Source: Partnership for Care: Scotland's Health White Paper, Scottish Executive, TSO (0870 606 5566)
Links: White Paper (pdf) | White Paper | Summary (pdf) | Summary | Press release
Date: 2003-Feb
An article argued that a Competition Commission judgement (in August 2002) could make all contracting out and commissioning of healthcare by the National Health Service and local authority social services departments subject to European Union competition law, rather than being a matter for national public health policy. They warned that this may leave the NHS vulnerable to legal challenge from international healthcare corporations. (The BetterCare Group - a private company selling nursing and residential care in Northern Ireland - used UK competition law to argue that the contract price for private nursing home beds was set too low, because the trust was abusing its dominant market position in violation of competition rules.)
Source: Allyson Pollock and David Price, 'The BetterCare judgment - a challenge to health care ', British Medical Journal 1.2.03
Links: Article
Date: 2003-Feb
The Secretary of State for Health called for greatly expanded patient choice, saying that this would require a 'fundamental culture change' in how the National Health Service works. He said that within three years all NHS patients in England will be given the option of being treated in a private hospital free of charge.
Source: Speech by Alan Milburn MP (Secretary of State for Health) 11.2.03
Links: Text of speech | Guardian report
Date: 2003-Feb
The Secretary of State for Health argued for a 'real localism' in health and other public services. He said that the 'top-down' approach of Labour's first term had delivered important results, but that a 'better balance' was needed between central direction and local autonomy. He suggested that local councils might be allowed to raise money to improve local health services, with voters consulted in local referenda.
Source: Speech by Alan Milburn MP (Secretary of State for Health) 5 February 2003
Links: Text of speech | BBC news report
Date: 2003-Feb
The Secretary of State for Health reportedly admitted that taxpayers are highly sceptical about reforms to the National Health Service; that it will take a long time for waiting times to be reduced to acceptable levels; and that plans to extend choice to patients are a 'huge lottery'.
Source: Comments by Alan Milburn MP (Secretary of State for Health) to conference of NHS executives, reported in The Observer, 16.2.03
Links: Observer report
Date: 2003-Feb
Doctors warned that new, semi-independent, foundation hospitals may increase health inequality by widening the gap between the best performing hospitals and those struggling to improve services.
Source: Health Select Committee Inquiry into Foundation Hospitals: Memorandum, British Medical Association (020 7383 6244)
Links: Submission | Press release
Date: 2003-Jan
