A series of annual reports summarized policy developments in European countries in the fields of pensions, healthcare, and long-term care. The United Kingdom report said that the existing structure of the pension system led to undersaving by a substantial proportion of the population; described the coalition government's plans for National Health Service reform as a 'big gamble' in the face of opposition from core stakeholders; and said that the social care system was in 'urgent need of reform'.
Source: Martin Seeleib-Kaiser, Pensions, Health Care and Long-term Care: United Kingdom Annual Report 2011, Analytic Support on the Socio-Economic Impact of Social Protection Reforms – Expert Network (European Commission)
Links: UK report | 2011 reports (links)
Date: 2011-Dec
A new book examined issues relating to healthcare and European Union law. As member states had increasingly experimented with new forms of funding and delivery in healthcare and social welfare services, healthcare issues had not escaped scrutiny from the EU internal market and from competition and procurement rules.
Source: Johan van de Gronden, Erika Szyszczak, Ulla Neergaard, and Markus Krajewski, Health Care and EU Law, TMC Asser Press
Links: Summary
Date: 2011-Dec
The coalition government tabled an amendment to the Health and Social Care Bill that would allow National Health Service foundation hospitals in England to raise up to 49 per cent of their funds from private patients – compared with the existing limit of 2 per cent.
Source: BBC report, 27 December 2011
Links: BBC report | Labour Party press release | Guardian report
Date: 2011-Dec
A chapter in the 2011-12 British Social Attitudes Survey report examined public attitudes towards the National Health Service. Satisfaction with the NHS overall was at its highest ever level, though the picture in relation to specific services was more mixed. Expectations about waiting times had improved dramatically over the previous decade.
Source: Elizabeth Clery, 'Taking the pulse: attitudes to the health service' (in Alison Park, Elizabeth Clery, John Curtice, Miranda Phillips, and David Utting (eds.), British Social Attitudes 28: 2011-2012 Edition), SAGE Publications
Links: Chapter
Date: 2011-Dec
An article sought to identify and evaluate potential strategies for increasing the impact of systematic reviews on policy in healthcare. Such strategies might include incorporating active strategies for dissemination and knowledge transfer: but more work was needed to evaluate their benefits.
Source: Frances Bunn and Katie Sworn, 'Strategies to promote the impact of systematic reviews on healthcare policy: a systematic review of the literature', Evidence & Policy, Volume 7 Number 4
Links: Abstract
Date: 2011-Dec
An article used data from a Department of Health funded study to explore the views of those working within the policy process about the role of evidence. It highlighted a tension between formative and summative uses of research; and also uncertainty about the status of 'pathfinder', 'demonstration', and 'pilot' sites within the policy process.
Source: Ailsa Cameron, Chris Salisbury, Rachel Lart, Kate Stewart, Stephen Peckham, Michael Calnan, Sarah Purdy, and Helen Thorp, 'Policy makers' perceptions on the use of evidence from evaluations', Evidence & Policy, Volume 7 Number 4
Links: Abstract
Date: 2011-Dec
A think-tank report described the National Health Service as an old-style nationalized service characterized by 'time wasting and inconvenience on a monumental scale', and as fundamentally incapable of serving its customers effectively. It called for the entire NHS estate to be sold to competing, private groups; and for a co-payments system whereby patients had to pay 20 per cent of medical bills themselves, up to a 'reasonable' annual limit.
Source: Chris Davies, Reforming the National Health Service: Reflections on four decades of NHS care, Adam Smith Institute
Date: 2011-Dec
A new textbook examined how government decisions around health were really made. It challenged the conception of policy as a rational process, highlighting instead knee-jerk reactions to disasters, keeping voters satisfied, the powerful leverage of interest groups, and the skewing of debate through ideology and the media.
Source: Andy Alaszewski and Patrick Brown, Making Health Policy: A critical introduction, Wiley
Links: Summary
Date: 2011-Dec
A new book examined the role that case studies played in understanding and explaining health policy.
Source: Mark Exworthy, Stephen Peckham, Martin Powell, and Alison Hann (eds.), Shaping Health Policy: Case study methods and analysis, Policy Press
Links: Summary
Date: 2011-Oct
The coalition government responded to a report by a committee of peers expressing concerns over the constitutional implications of the Health and Social Care Bill. It denied that the Bill would alter the responsibility of the Secretary of State for the running of the National Health Service.
Source: Letter 10 October 2011, Department of Health
Links: Letter
Notes: Peers report
Date: 2011-Oct
A paper said that attempts by western governments to contain healthcare spending would fail without a 'significant transformation' of the ideological context that had favoured the birth and development of existing healthcare systems. In particular, the 'myth of social justice' and the concept of human dignity needed to be 'reassessed'.
Source: Enrico Colombatto, Is There a Health-Care Problem in Western Societies?, Working Paper 14/2011, International Centre for Economic Research (Prague/Piedmont)
Links: Paper
Date: 2011-Oct
A new book (by the former chief executive of the National Health Service) charted attempts to reform the NHS under the former Labour governments between 2000 and 2006.
Source: Nigel Crisp, 24 Hours to Save The NHS: The chief executive's account of reform 2000 to 2006, Oxford University Press
Links: Summary
Date: 2011-Oct
The Health and Social Care Bill was given a third reading. The Bill was designed to abolish primary care trusts in England, and replace them with clinical commissioning groups. It would also compel all hospitals in England to become foundation trusts.
Source: Health and Social Care Bill, Department of Health, TSO | Debate 7 September 2011, columns 362-501, House of Commons Hansard, TSO
Links: Bill | Explanatory notes | Hansard | RCM press release | RCN press release | Public Finance report
Date: 2011-Sep
A report provided an overview of the healthcare system in England, and of recent policy developments.
Source: Sean Boyle, United Kingdom (England): Health System Review 2011, European Observatory on Health Systems and Policies
Links: Report
Date: 2011-Sep
An article examined European Union healthcare policy from the point of view of human rights law. EU policy had promoted an individualist, rather than a communitarian, view of the right to healthcare.
Source: Danielle da Costa Leite Borges, 'Making sense of human rights in the context of European Union health-care policy: individualist and communitarian views', International Journal of Law in Context, Volume 7 Issue 3
Links: Abstract
Date: 2011-Sep
The Department of Health published its annual report and accounts for 2010-11.
Source: Annual Report and Accounts 2010-11, HC 1011, Department of Health, TSO
Links: Report
Date: 2011-Sep
A report by a committee of peers said that the coalition government's Health and Social Care Bill risked diluting the government's constitutional responsibilities with regard to the National Health Service in England, by dividing statutory duties between the Secretary of State, a new NHS Commissioning Board, and new clinical commissioning groups.
Source: Health and Social Care Bill, 18th Report (Session 2010-12), HL 197, House of Lords Constitution Select Committee, TSO
Links: Report | Guardian report
Date: 2011-Sep
An article examined whether decisions affecting healthcare policy during acute economic crises were fundamentally different from those normally observed over the longer period of cost-containment policy, based on a study of the United Kingdom and Italy. Although acute economic crises created 'windows of opportunity' for change, it was the interaction of system-specific deficits and the role of ideas and political factors that largely conditioned the content and timing of reforms.
Source: Lorraine Frisina Doetter and Ralf Gotze, 'Health care policy for better or for worse? Examining NHS reforms during times of economic crisis versus relative stability', Social Policy and Administration, Volume 45 Number 4
Links: Abstract
Date: 2011-Aug
An article examined evidence relating to the effectiveness of strategies to increase the use of research in healthcare policy decisions.
Source: Gabriel Moore, Sally Redman, Mary Haines, and Angela Todd, 'What works to increase the use of research in population health policy and programmes: a review', Evidence & Policy, Volume 7 Number 3
Links: Abstract
Date: 2011-Aug
Four linked briefing papers examined the implications of the coalition government's healthcare reform programme for the housing sector.
Source: Merron Simpson and Kate McAllister, Housing Support and Personalisation: Practical advice for the current moment, Housing Learning and Improvement Network | Gill Leng, Public Health and Housing: We can get it right, Housing Learning and Improvement Network | Steve Appleton, The New NHS Commissioning Landscape and Its Impact on Housing and Care for Older People, Housing Learning and Improvement Network | Peter Molyneux, Opportunities to Improve Health and Well-being: Integrating secondary and acute health care and housing in the new NHS, Housing Learning and Improvement Network
Links: Paper (1) | Paper (2) | Paper (3) | Paper (4)
Date: 2011-Aug
A new book examined how the development and implementation of policy and strategy provided the framework for improving quality, innovation, productivity, and prevention in the delivery of healthcare.
Source: Elizabeth Porter and Lesley Coles, Policy and Strategy for Improving Health and Wellbeing, Learning Matters
Links: Summary
Date: 2011-Jul
A new book examined the relationship between health systems, health, and economic wealth in European countries.
Source: Martin McKee, Josep Figueras, and Richard Saltman, Health Systems: Health, Wealth, Society and Well-Being, Open University Press
Links: Summary
Date: 2011-Jul
A new book examined the relationship between evidence, policy, and practice in health and social care. It considered how policy was implemented, and how research could and should influence the policy process. It criticized the notion of 'evidence-based practice', suggesting instead a more inclusive idea of 'knowledge-based practice', based in part on the lived experience of service users.
Source: Jon Glasby (ed.), Evidence, Policy and Practice: Critical perspectives in health and social care, Policy Press
Links: Summary
Date: 2011-Jun
The Prime Minister announced that the coalition government would be making a series of changes to its proposals for National Health Service reform, following the end of a 'listening exercise'. The 2013 deadline for family doctor consortiums to take over the commissioning of healthcare care would be dropped: commissioning would go ahead only when the consortiums were 'good and ready'. The role of Monitor, set to become the economic regulator of the NHS, would be expanded to include a duty to integrate services to provide joined-up care.
Source: Speech by David Cameron MP (Prime Minister), 7 June 2011
Links: Speech | Downing Street press release | Conservative Party press release | RCN press release | RCP press release | Unite press release | Community Care report | Guardian report (1) | Guardian report (2) | Public Finance report | Telegraph report
Date: 2011-Jun
The government responded to a report by a committee of MPs on its plans to reform commissioning arrangements in the National Health Service in England. In the light of the results of a 'listening exercise', significant changes to the plans would be made. Clinical commissioning groups would need to pass a 'rigorous' authorization test before they were given the freedom to manage local NHS budgets and take on other functions, and would be held to account by the NHS Commissioning Board for ensuring they maintained these standards.
Source: Government Response to the House of Commons Health Select Committee Fifth Report of Session 2010-11: Commissioning, Cm 8100, Department of Health, TSO
Links: Response
Notes: MPs report (April 2011)
Date: 2011-Jun
The coalition government published its detailed response to the findings of a review of its plans to reform the National Health Service in England. It reiterated its acceptance of the review's core recommendations.
Source: Government Response to the NHS Future Forum Report, Cm 8113, Department of Health, TSO
Links: Response | Hansard | DH press release | Brief on Bill amendments | NCF press release
Notes: Forum summary report (June 2011)
Date: 2011-Jun
The report of a government-commissioned review (chaired by Steve Field) said that the coalition government's plans to reform the National Health Service in England needed to be substantially rewritten:
• Although consortiums of family doctors (to be called clinical commissioning groups ) should be given greater powers to commission services, they should consult with other professionals: 'clinical senates' made up of a variety of different experts, including hospital doctors and nurses, should be created to oversee the new system.
• Consortiums should only take on their new responsibilities when they were ready, instead of by the original deadline of 2013.
• The NHS regulator should focus on ensuring patients had greater choice, rather than promoting competition: the roles of competition, collaboration, and integration should all be recognized. Patients should be given a new (undefined) 'right to challenge' to put pressure on NHS standards.
• Central government should retain legal responsibility for the overall performance of the NHS.
The coalition government responded by saying that it accepted all the core recommendations in the report.
Source: NHS Future Forum, Summary Report on Proposed Changes to the NHS, Department of Health | Government Changes in Response to the NHS Future Forum, Department of Health
Links: Forum summary report | Choice and competition report | Clinical advice and leadership report | Education and training report | Patient involvement and public accountability report | Government response | Hansard | DH press release | Conservative Party press release | DPM speech | ADASS press release | Alzheimers Society press release | BMA press release | CBI press release | CSP press release | Kings Fund press release (1) | Kings Fund press release (2) | Labour Party press release | LGA press release | MHF press release | Monitor press release | NCB press release | NHS Alliance press release | NHS Confederation press release | Nuffield Trust press release | Patients Association press release | RCGP press release | RCN press release | RCP press release | RCPsych press release | RCS press release | Rethink press release (1) | Rethink press release (2) | St Mungos press release | UNISON press release | Unite press release | BBC report (1) | BBC report (2) | Community Care report (1) | Community Care report (2) | Daily Mail report (including PM article) | Guardian report (1) | Guardian report (2) | Telegraph report (1) | Telegraph report (2)
Date: 2011-Jun
A commission report made recommendations designed to maintain and enhance the National Health Service in Wales as a 'values-based' service true to its founding principles. As the NHS in Wales followed a path that increasingly diverged from healthcare provision in many other European countries, the moral principles underlying collective, planned provision needed to be renewed and rearticulated, emphasizing that in a world of increasing competition the NHS was an organization that served the needs of the people and sought to redress social inequities.
Source: Bevan Commission, 2008-2011 NHS Wales: Forging a Better Future, Welsh Assembly Government
Links: Report | Cardiff University press release
Date: 2011-Jun
A report called for a series of changes or clarifications to the coalition government's planned reforms of the National Health Service. It said that legislation should make it clear that the government had a duty to provide, or secure provision for, a comprehensive health service throughout England. Commissioners or providers should not be able to charge patients for healthcare services that were currently provided free by the NHS or were recommended by NICE.
Source: The Government's Health Reforms: An Analysis of the Need for Clarification and Change, Royal College of General Practitioners
Links: Report | RCGP press release
Date: 2011-May
A think-tank report examined accountability for commissioners and providers of healthcare in the National Health Service – both as it existed and under the reforms set out in the Health and Social Care Bill. It concluded that the proposed reforms were likely to meet the coalition government's aim of reducing centralized control, but would fail to deliver on its commitment to improve local accountability – potentially undermining the performance of key NHS organizations as a result.
Source: Jo Maybin, Rachael Addicott, Anna Dixon, and John Storey, Accountability in the NHS: Implications of the government s reform programme, King s Fund
Links: Report | Kings Fund press release | Public Finance report
Date: 2011-May
A special journal issue compared and contrasted healthcare policy in the United Kingdom and the United States of America.
Source: Journal of Health Politics, Policy and Law, Volume 36 Number 1
Links: Table of contents
Date: 2011-May
A think-tank paper said that the coalition government's plan to make the National Health Service accountable to three different groups – family doctor consortiums, local government, and the Department of Health – would make it 'next to impossible' for patients to work out who actually was responsible for delivering better healthcare. Instead the government should make the NHS accountable to patients, by giving them genuine choice over the organizations that bought healthcare on their behalf, on the model of countries such as the Netherlands, Germany, and Switzerland.
Source: An NHS for Patients, Reform
Links: Paper
Date: 2011-May
The government announced that it would 'take the opportunity of a natural break' in the passage of the Health and Social Care Bill to conduct a further consultation on its plans to 'modernize' the National Health Service, and would subsequently 'bring forward amendments to improve the plans further in the normal way'.
Source: Debate 4 April 2011, columns 767-785, House of Commons Hansard, TSO
Links: Hansard | DH press release | PM speech | Labour Party press release | BMA press release | GMB press release | Kings Fund press release | Mind press release | NCF press release | NHS Confederation press release | Rethink press release | Unite press release | BBC report | Guardian report (1) | Guardian report (2)
Date: 2011-Apr
A paper examined the degrees of change and continuity associated with the coalition government's key proposals for National Health Service reform. Rather than radical 'third order' change, the reform programme combined incremental changes to previous policies with the creation of new policy mechanisms designed to create a new strategic direction in reform efforts.
Source: Ross Millar, Iain Snelling, and Hilary Brown, Liberating the NHS: Orders of Change?, Health Services Management Centre (University of Birmingham)
Date: 2011-Apr
A report by a committee of MPs said that the government's planned restructuring of the National Health Service contained a variety of risks that could prevent the service from achieving its target of £20 billion efficiency gains by 2014-15. Replacing the existing structure of primary care trusts with commissioning consortiums of family doctors might cost more than double the government's estimate of £1.4 billion.
Source: National Health Service Landscape Review, Thirty-third Report (Session 2010-11), HC 764, House of Commons Public Accounts Select Committee, TSO
Links: Report | DH press release | NHS Confederation press release | UNISON press release | BBC report | Guardian report | Public Finance report
Date: 2011-Apr
A think-tank report said that the government should reduce the pace of its health reforms. The Health and Social Care Bill's proposals to abolish every primary care trust by 2013 could lead to the new structure replicating the existing system in all but name.
Source: Eve Norridge, Implementing GP Commissioning, Policy Exchange
Links: Report | Policy Exchange press release | Guardian report
Date: 2011-Apr
A report by a committee of MPs said that a series of modifications were needed to the government's plan to give consortiums of family doctors power to commission nearly all National Health Service provision. These included safeguards in relation to accountability, governance standards, and potential conflicts of interest. Commissioning consortium boards should be enlarged to include hospital doctors, directors of public health, and nurses.
Source: Commissioning: Further Issues, Fifth Report (Session 2010-11), HC 796, House of Commons Health Select Committee, TSO
Links: Report | DH press release | Alzheimers Society press release | Kings Fund press release | NHS Confederation press release | RCN press release | RCP press release | RCS press release | 2020health press release | Unite press release
Date: 2011-Apr
A pamphlet (by a former health minister) said that the coalition government's plans for National Health Service reform displayed 'staggering ineptitude'. The role of an internal market in the NHS was essential: but imposing an external market would be destructive, challenging the very nature of the vocational aspect of medicine.
Source: David Owen, Fatally Flawed: Yes to the NHS internal market – No to the external market, David Owen
Links: Pamphlet
Date: 2011-Mar
A report examined possible scenarios for the future reform of healthcare systems in Europe.
Source: Alexandra Wyke, The Future of Healthcare in Europe, Economist Intelligence Unit
Date: 2011-Mar
A paper examined the regulation of social security and healthcare in European Union law – and the issues of competition, free movement, and state aid that were involved.
Source: Daniele Gallo, Social Security and Health Services in EU Law: Towards convergence or divergence in competition state aids and free movement?, Working Paper 2011/19, Robert Schuman Centre for Advanced Studies, European University Institute (Florence)
Links: Paper
Date: 2011-Mar
A paper said that the European Union cross-border healthcare directive would further undermine social healthcare provision in the United Kingdom, in favour of 'economic' rights and the 'choice agenda'.
Source: Andy Morton, A Single European Market in Healthcare: The impact of European Union policy on national healthcare provision, European Services Strategy Unit
Links: Paper
Date: 2011-Mar
A paper examined concerns raised about the government's proposed National Health Service reforms, and suggested practical measures that the government could take to address them. There had often been a 'reality gap' between ideas that were good in principle and the details of practical delivery, which had often looked opaque or too optimistic.
Source: Where Next for NHS Reform?, NHS Confederation
Links: Paper | NHS Confederation press release | Guardian report
Date: 2011-Mar
A think-tank report called for a single performance framework to ensure that National Health Service and social care services worked together to improve outcomes for patients and service users. Government plans for separate outcomes frameworks for the NHS, social care, and public health could threaten effective joint working at a local level, reducing benefits for patients and service users.
Source: Richard Humphries and Natasha Curry, Integrating Health and Social Care: Where Next?, King s Fund
Links: Report | Kings Fund press release
Date: 2011-Mar
An audit report examined the government's plans for National Health Service reform in England. It warned that the plans could have highly damaging effects on both costs and the quality of care if not handled properly.
Source: National Health Service Landscape Review, HC 708 (Session 2010-11), National Audit Office, TSO
Links: Report | Guardian report
Date: 2011-Jan
The government responded to a report by a committee of MPs on its plans for wholesale reform of commissioning in the National Health Service. It said that although the proposal to abolish primary care trusts had not been in the Conservative or Liberal Democrat election manifestos, or even in the coalition government's agreed programme, it was simply a 'logical consequence' of other proposals – that is, to transfer the trusts' main responsibilities to other bodies including local government.
Source: Government Response to the House of Commons Health Select Committee Third Report of Session 2010-11: Commissioning, Cm 8009, Department of Health, TSO
Notes: The MPs' report had said that the proposal represented a 'high-risk' strategy.
Date: 2011-Jan
A think-tank report (based on a study of experiences in the United States of America) said that substantial investment in leadership, management, and information technology – combined with a focus on helping family doctors to work in new ways, and collaborate more closely with their specialist colleagues – was vital if the government's plan to give control of National Health Service budgets to groups of family doctors were to succeed.
Source: Ruth Thorlby, Rebecca Rosen and Judith Smith, GP Commissioning: Insights from Medical Groups in the United States, Nuffield Trust
Links: Report | Nuffield Trust press release | Guardian report
>Date: 2011-Jan
The Health and Social Care Bill was published, and given a second reading. The Bill included measures to:
• Give new consortiums of family doctors across England the task of commissioning the healthcare they deemed appropriate for their patients, and control over the budget – £80 billion – to pay for that.
• Make the National Health Service more accountable to patients and the public by establishing 'Healthwatch', a new independent body that could look into complaints and scrutinize the performance of local health providers.
• Compel all hospitals in England to become foundation trust hospitals (semi-independent of central control) with the freedom to earn money by treating private patients.
• Improve public health by establishing a new body, called Public Health England, to improve public health and reduce health inequalities.
Abolish primary care trusts and strategic health authorities by 2013, and abolish many arm's-length bodies (including the Health Protection Agency and Human Fertilisation and Embryology Authority).
Source: Health and Social Care Bill, Department of Health, TSO | Debate 31 January 2011, columns 605-704, House of Commons Hansard, TSO
Links: Bill | Explanatory notes | Co-ordinating document | Impact assessments | Equality impact assessments | DH press release | Hansard (second reading) | HOC research brief | Conservative Party press release | Liberal Democrats briefing | ADASS press release | Age UK press release | BMA press release | Civitas press release | Council and Care press release | DrugScope press release | ERoSH press release | FTN press release | Green Party press release | GSCC press release | Kings Fund press release | Labour Party press release | LGA press release | Mencap press release | NHS Confederation press release | NHS Confederation briefing | Nuffield Trust press release | Patients Association press release | RCGP press release | RCM press release | RCN press release | RCPsych press release | Rethink press release | Scope press release | TUC press release | Unite press release | BBC report | Community Care report | Children & Young People Now report | Telegraph report | Guardian report | Socialist Worker report
Date: 2011-Jan
A report by a committee of MPs said that the government was right to seek to enhance the effectiveness of commissioning within the National Health Service. But the 2010 White Paper had involved a 'significant policy shift' that would entail 'institutional upheaval' rather than evolutionary change. This change of policy had not yet been sufficiently explained, given the costs and uncertainties generated by the process. The separate aim of making £15-20 billion in efficiency savings was already a high-risk strategy, and the White Paper increased the level of risk considerably without setting out a credible plan for mitigating it.
Source: Commissioning, Third Report (Session 2010-11), HC 513, House of Commons Health Select Committee, TSO
Links: Report | BMA press release | Kings Fund press release | Mind press release | Nuffield Trust press release | Unite press release | Public Finance report | Guardian report | BBC report
Date: 2011-Jan
A paper examined the impact of rulings of the European Court of Justice (with regard to patient mobility) on European integration of national healthcare systems. The effects of these rulings went beyond the narrow issue of patient mobility, and could have an important impact on the domestic healthcare systems.
Source: Rita Baeten, Bart Vanhercke, and Michael Coucheir The Europeanisation of National Health Care Systems: Creative adaptation in the shadow of patient mobility case law, Research Paper 3, European Social Observatory (Brussels)
Links: Paper
Date: 2011-Jan
A report said that there were real potential benefits in the new government's plans to move decision-making closer to family doctors, and in extending the range of healthcare providers. But it highlighted a series of risks associated with the proposals. Significant cultural and behavioural changes would be required, and low involvement by family doctors was among the biggest threats to success.
Source: Liberating the NHS. What Might Happen?, NHS Confederation
Links: Report | NHS Confederation press release | BMA press release | DH press release | RCN press release | Unite press release | Children & Young People Now report | BBC report | Guardian report
Date: 2011-Jan
