A think-tank report said that the National Health Service was failing, and would continue to fail. The gap between the government s claims for progress in NHS reform and the experience of the patient was 'huge'. Excessive government targets and bureaucracy were preventing healthcare professionals and National Health Service managers from running an effective health service. The report was criticised by NHS organisations.
Source: Harriet Sergeant, Managing not to Manage: Management in the NHS, Centre for Policy Studies (020 7222 4488)
Links: Report (pdf) | CPS press release (pdf) | NHS Confederation press release | Guardian report
Date: 2003-Dec
Following consultation, the government announced action to prevent access to the National Health Service by so-called 'health tourists'. Failed asylum seekers and others with no legal right to be in the country would be stopped from receiving free treatment for conditions which arose after their legal status had been finally determined; the dependants and spouse of someone who was permanently resident in the United Kingdom would no longer be able to visit the country briefly to obtain free treatment unless they had permanent residence themselves; and business travellers and their dependants who fell ill or were injured on a trip to the United Kingdom would no longer be eligible. Doctors warned that it was not their role to be the agents of the state in policing eligibility for healthcare.
Source: Press release 31 December 2003, Department of Health (020 7210 4850) | National Health Service (Charges to Overseas Visitors) Regulations 1989: Consultation - Summary of outcome, Department of Health (08701 555455) | Press release 30 December 2003, British Medical Association (020 7387 4499)
Links: DH press release | Consultation summary (pdf) | BMA press release | Refugee Council press release | Guardian report
Date: 2003-Dec
A report said that a pilot scheme, which offered fast-track treatment to National Health Service heart patients prepared to travel to an alternative hospital, had been voted an overwhelming success by the patients themselves.
Source: Naomi LeMaistre, Rachel Reeves and Angela Coulter, Patients' Experience of CHD Choice, Picker Institute Europe (01865 208100)
Links: Report (pdf) | Picker Institute press release (Word file)
Date: 2003-Dec
A new book considers the meaning of 'access' in healthcare and examined the theoretical issues underpinning these questions. Contributors investigated key aspects of access, including: geographical accessibility of services; socio-economic equity of access; patients' help-seeking behaviour; organisational problems and access; and methods for evaluating access.
Source: Martin Gulliford and Myfanwy Morgan (eds.), Access to Health Care, Routledge (01264 343071)
Links: Summary
Date: 2003-Dec
The government published a White Paper on extending patient choice within the National Health Service, including the results of a national consultation. It said that everyone wanted the opportunity to share in decisions about their health and healthcare, and to make choices about that care where appropriate. The Health Secretary commented: 'Choice is the route to equity as well as excellence'.
Source: Building on the Best: Choice, responsiveness and equity in the NHS, White Paper Cm 6079, Department of Health, TSO (0870 600 5522) | Press release 9 December 2003, Department of Health (020 7210 4850)
Links: White Paper (pdf) | Summary (pdf) | DH press release | NHS Confederation press release | Mind press release | Rethink press release | Guardian report
Date: 2003-Dec
A report said that the relationship between government and the United Kingdom pharmaceutical industry had focused too heavily on developing new medicinal drugs, to the detriment of research into other ways of improving health. It also said the pharmaceutical industry had neglected major groups, such as children, women and older people, whose specific health needs were not taken fully into account.
Source: Anthony Harrison, Getting the Right Medicines?: Putting public interests at the heart of health-related research, King s Fund (020 7307 2591)
Links: Summary (pdf) | KF press release | Guardian report
Date: 2003-Dec
The government announced a further wave ('1a') of 32 bids for foundation trust status from October 2004. When added to the 25 trusts in 'wave 1' already due to be established in April 2004, the new trusts would cover 25 per cent of the population. The government said an evaluation of the trusts would be carried out after the first year of operation. It was accused of breaking a promise to backbench opponents of foundation trusts that a second wave would not be approved until after the evaluation had taken place.
Source: Press release 25 November 2003, Department of Health (020 7210 4850)
Links: DH press release | King's Fund press release | Guardian report
Date: 2003-Nov
A document identified the national priorities and targets which National Health Service organisations needed to build into their local plans for the period up to 2006.
Source: Improvement, Expansion and Reform: The next three years' priorities and planning framework, 2003-2006 (2001), Department of Health (08701 555455)
Links: Report (pdf)
Date: 2003-Nov
The High Court ruled that patients facing 'undue delay' in obtaining treatment from the National Health Service were entitled under European law to obtain funding for overseas treatment.
Source: R (Watts) v Bedford Primary Care Trust and Another, High Court 1 October 2003
Links: Law report | Guardian report
Date: 2003-Oct
The National Audit Office reportedly began an investigation into suggestions that National Health Service hospitals were effectively losing millions of pounds to subsidise the treatment of private patients, as a result of inadequate financial controls. The finance director of the NHS also reportedly admitted to a committee of MPs that the NHS was paying around 40 per cent more for operations in the private sector than the same procedures would cost if they were carried out in NHS hospitals: he admitted that relevant (unpublished) figures produced by the Office for Health Economics were 'a reasonable piece of work'.
Source: The Guardian, 27 and 28 October 2003
Links: Guardian report 27/10 | Guardian report 28/10
Date: 2003-Oct
The government announced the contract award for a new national electronic booking system for the National Health Service in England. The system would enable patients to choose which hospital they would like to attend, at a date and time to suit them. (The first electronic bookings are expected in summer 2004, with implementation due to be completed by the end of 2005.)
Source: Press release 8 October 2003, Department of Health (020 7210 4850)
Links: DH press release | Guardian report
Date: 2003-Oct
The government announced that a new post of 'National Director for Social Care' was being created to strengthen relationships between the Department of Health and local authority social services, and to spearhead attempts to tackle the problem of 'bed blocking' (older people being forced to stay in hospital when they were medically fit to leave).
Source: Press release 17 October 2003, Department of Health (020 7210 4850)
Links: DH press release | GSCC press release | Community Care article | Guardian article
Date: 2003-Oct
A research report identified the support needed by local health services in Scotland to better meet the needs of individuals from lesbian, gay, bisexual and transgender communities.
Source: Towards a Healthier LGBT Scotland, INCLUSION Project (Stonewall Scotland/Scottish Executive Health Department) (0141 204 0746)
Links: Report (pdf) | Citizenship 21 press release
Date: 2003-Oct
A report said that primary care trusts in England faced constraints when delivering health care services to rural areas: a survey identified lack of transport, access to services, and the extra cost of delivering services in rural areas as the main problems.
Source: Helen Swindlehurst, Rural Proofing for Health: Analysis of the consultation with primary care trusts, Institute of Rural Health (01686 650800)
Links: IRH press release
Date: 2003-Oct
A report provided an overview of the current planning requirements for local public services, with particular focus on local authorities and the National Health Service; described key challenges to improving joint strategic planning and the progress made by a number of local partnerships across England and Wales; suggested ideas for action and a framework for local strategic planning, based on what had worked well in these partnerships; and outlined current approaches to joint strategic planning and commissioning through 21 detailed case studies.
Source: Lucy Hamer, Planning with a Purpose - Local authorities and the NHS: planning together to improve health and well- being across the local strategic partnership, Local Government Association (020 7664 3000), Health Development Agency and NHS Confederation
Links: Report (pdf)
Date: 2003-Oct
The government said that it would examine why care trusts (bringing together adult health and social care services into a single organisation) had not been as popular or successful as anticipated. It said that care trusts might not be the best means of integrating health and social services, and that more flexible partnership arrangements could prove more effective. The announcement followed the dissolution of a pioneering partnership between a social services department and a primary care trust in east London.
Source: The Guardian, 25 September 2003 | The Guardian, 3 September 2003
Links: Guardian report 25/9 | Guardian report 3/9
Date: 2003-Sep
A report recommended the introduction of a 'resource use measure' tool in Scotland to promote fairer access to nursing and personal care resources for older people, and improve equity of resource allocation. The tool would group individuals according to a standardised measure of relative need.
Source: Report on the Development of a Resource Use Measure (RUM) for Scotland, Scottish Executive (0131 556 8400)
Links: Report
Date: 2003-Sep
Researchers evaluated the condition of partnership working between the National Health Service and local authorities in Wales. They said that partnership was progressing at a 'modest and manageable pace'.
Source: Ruth Young, Brian Hardy, Eileen Waddington and Nigel Jones, Partnership Working: Study of NHS and local authority services in Wales, Manchester Centre for Healthcare Management/University of Manchester (0161 273 2908) and Nuffield Institute for Health
Links: Report (pdf)
Date: 2003-Sep
A report called for a redesign of community nursing, primary care and child health surveillance systems in Scotland, to provide a comprehensive and consistent framework for assessing children s health needs.
Source: Making it Work for Scotland s Children: Child health support group overview report 2003, Scottish Executive, TSO (0870 606 5566)
Links: Report | Summary | SE press release
Date: 2003-Sep
The government announced plans for the commissioning of new 'diagnostic treatment centres' from private providers, covering 26 areas from 2004, designed to help cut National Health Service waiting lists. Of the programme s planned 250,000 operations, 135,000 would be additional, while 115,000 would be transferred from existing NHS resources. Doctors welcomed the new centres, but expressed a number of concerns - in particular over sources of funding. The government reportedly reneged on a previous pledge that all the capacity provided by the new centres would be additional to NHS resources: confidential guidance to NHS trusts allowed up to 70 per cent of the centres' staff to be seconded from the NHS.
Source: Press release 12 September 2003, Department of Health (020 7210 4850) | Press release 12 September 2003, British Medical Association (020 7387 4499) | The Guardian, 10 September 2003
Links: DH press release | BMA press release | Guardian report (1) | Guardian report (2)
Date: 2003-Sep
Date: 2003-Aug
The government began consultation on a new system of payment by results within the National Health Service, which it said was necessary to support a devolved health system. It said the new system would pay NHS trusts and other providers 'fairly and transparently' for services delivered; reward efficiency and quality in providing services; support greater patient choice and more responsive services; and enable primary care trusts to concentrate on quality and quantity rather than price. The new system would apply to NHS foundation trusts from April 2004, and to all NHS Trusts from April 2005.
Source: Payment by Results Consultation: Preparing for 2005, Department of Health (08701 555455)
Links: Consultation document (pdf)
Date: 2003-Aug
The Department of Health published its 2003 annual report. In an introduction, the Health Secretary said that historic levels of investment in the National Health Service, coupled with wide-ranging reforms, meant that the government would deliver the NHS needed to meet the growing expectations of patients.
Source: Department of Health: Departmental Report 2003, Department of Health, TSO (0870 600 5522)
Links: Report (pdf links)
Date: 2003-Jul
A committee of MPs called for a shift towards midwife bookings, greater autonomy for midwives in delivering services, and a greater priority given by trusts to maternity issues, in order to help reverse the 'worrying medicalisation' of birth.
Source: Choice in Maternity Services, Ninth Report (Session 2002-03), HC 796-I, House of Commons Health Select Committee, TSO (0870 600 5522)
Links: Report | Guardian report
Date: 2003-Jul
The Scottish Executive began consultation on proposals to devolve responsibility for local health services to new community health partnerships (part of the NHS Reform (Scotland) Bill).
Source: Community Health Partnerships: Consultation paper on guidance, Scottish Executive (0131 556 2242)
Links: Consultation document (pdf) | SE press release
Date: 2003-Jul
The government announced the creation of 35 children s trust pathfinders, bringing together children s social services, education and health services into a single local structure.
Source: Press release 10.7.03, Department for Education and Skills (0870 000 2288)
Links: DfES press release
Date: 2003-Jul
A report by the Audit Commission said that National Health Service targets and action plans were helping to improve services to patients, but the way these targets were being met meant that the progress might not continue in the longer term. It said that a number of trusts were finding short-term solutions to keep everyday services going by taking money away from the longer-term modernisation of the NHS.
Source: Achieving the NHS Plan: Assessment of current performance, likely future progress and capacity to improve, Audit Commission (0800 502030)
Links: Audit Commission press release | Institute of Healthcare Management press release
Date: 2003-Jun
A review of progress in race equality in strategic health authorities in England (undertaken during 2002) found a lack of knowledge and understanding of the Race Relations (Amendment) Act 2000 and its implications; lack of clarity about the relationship between the implementation of the Act and delivery of the modernisation agenda and NHS Plan; and differences in understanding of the role of strategic health authorities in performance management of this area.
Source: Chetan Bhatt, Promoting Race Equality in the English NHS: Progress review, Commission for Racial Equality (020 7939 0000)
Links: Report (Word file) | CRE response (Word file)
Date: 2003-Jun
A report said that the views and needs of young people should be taken into account at all stages of the planning and delivery of health services for adolescents; and that health strategies should address the particular needs of adolescents, especially in relation to sexual health, substance abuse, mental health and accident prevention.
Source: Intercollegiate Working Party On Adolescent Health, Bridging the Gaps: Health care for adolescents, Royal College of Paediatrics and Child Health (020 7307 5600)
Links: Report (pdf)
Date: 2003-Jun
A guide examined the practical implications of achieving greater integration between health and social care services.
Source: Margaret Edwards and Clive Miller, Integrating Health and Social Care, Office of Public Management (020 7239 7800)
Links: OPM homepage
Date: 2003-Jun
A discussion paper said that the government s commitment to extending patient choice was helping drive down waiting times and improve efficiency: but that it could put at risk equal access to healthcare for equal need.
Source: John Appleby, Anthony Harrison and Nancy Devlin, What is the Real Cost of More Patient Choice?, King s Fund (020 7307 2591)
Links: Report (pdf) | King's Fund press release
Date: 2003-Jun
A report said that government policy was creating an internal market within the National Health Service: but, while some of the key problems associated with the market introduced by the previous (Conservative) Government in 1991 did appear to have been addressed, it was still unclear whether the policy could produce real benefits.
Source: Jennifer Dixon, Julian Le Grand and Peter Smith, Can Market Forces be used for Good?, King s Fund (020 7307 2591)
Links: Report (pdf) | Press release
Date: 2003-May
The government published details of a new 'NHS Improvement' programme to raise standards across the National Health Service, including 200 million of financial support, and to help all hospitals achieve foundation status 'within four or five years'. It also published the names of 29 NHS trusts which would form the first wave of applicants for foundation trust status, subject to Parliament passing the relevant legislation, in April 2004.
Source: Raising Standards - Improving performance in the NHS, Department of Health (08701 555455) | Press releases 6.5.03 and 14.5.03, Department of Health (020 7210 4850)
Links: Report (pdf) | DH press release 6/5
Date: 2003-May
The Health (Wales) Bill received Royal assent. The new Act gave a new role to reformed community health councils.
Source: Health (Wales) Act 2003, TSO (0870 600 5522)
Links: Text of Act
Date: 2003-Apr
A case study in Lothian (Scotland) found that the private finance initiative had not reached its targets for inpatient admissions and performance. Instead the effect had been a cut in services and downsizing of hospital and community facilities compared with other National Health Service hospitals in Scotland. Health officials reportedly criticised the study's conclusions as 'spurious' and 'total nonsense'.
Source: Matthew Dunnigan and Allyson Pollock, 'Downsizing of acute inpatient beds associated with private finance: Scotland's case study', British Medical Journal 26.4.03 | The Guardian, 26.4.03 | The Independent, 25.4.03
Links: BMJ article | Guardian report
Date: 2003-Apr
New National Health Service prescription charges came into effect from 1 April 2003. Charges were increased from 6.20 to 6.30 (1.6 per cent) for the supply of drugs and appliances.
Source: The National Health Service (Charges for Drugs and Appliances) Amendment Regulations 2003, Statutory Instrument 2003/585, TSO (0870 600 5522)
Links: Statutory Instrument
Date: 2003-Apr
Official guidance was issued (for consultation) designed to encourage the development of smaller local hospitals. The government said that new resources and new models of care show that 'small can work', with the potential for a wider range of safe, effective, high-quality care to be offered in smaller hospitals than previously thought possible.
Source: Keeping the NHS Local: A New Direction of Travel, Department of Health (08701 555455) | Press release 14.2.03, Department of Health (020 7210 4850)
Links: DH press release
Date: 2003-Feb
Tackling age discrimination must be pushed higher up the health and social care agenda, a report argued. It said that older people could miss out on vital services because of a lack of expertise by providers in identifying age discrimination.
Source: Ros Levenson, Auditing Age Discrimination: A practical approach to promoting equality in health and social care, King s Fund (020 7307 2591)
Links: Summary (pdf) | KF press release | Help the Aged press release
Date: 2003-Feb
The government announced that, from July 2003, the 'patient choice' programme will be extended to more parts of the country and more surgical specialties. (This followed two pilot schemes, started in 2002, covering heart and cataract surgery.) For the first time some patients will be offered a choice of hospital at the point they are referred for specialist treatment by a general practitioner, as well as after waiting six months or more for treatment.
Source: Press release 11.2.03, Department of Health (020 7210 4850)
Links: DH press release
Date: 2003-Feb
From 1 April 2003 local health boards took over responsibility for health services in Wales. The boards matched local authority areas, with a view to allowing health and social services to work more closely together. They were given responsibility for commissioning healthcare in their area, and would receive their funding direct from the Welsh Assembly Government.
Source: Press release 1.4.03, Welsh Assembly Government (029 2082 5111)
Links: WAG press release | NHS Wales leaflet (pdf)
Date: 2003-Feb
A report examined the distinctive health needs of ethnic minority communities in Scotland.
Source: Fair for All, Scottish Executive (0131 556 8400)
Links: Report | Press release
Date: 2003-Feb
The Welsh Assembly Government set out an integrated and multi-disciplinary approach to local authority and National Health Service strategic planning for health, social care and well-being. It identified the partnership principles underpinning implementation of the policy, and described the roles and responsibilities of both statutory and non-statutory stakeholders.
Source: Health, Social Care and Well-being Strategies: Policy Guidance, NHS in Wales/Welsh Assembly Government (029 2082 3286)
Links: Guidance (pdf) | Summary (pdf)
Date: 2003-Feb
A strategic framework was published for the future of palliative care services in Wales. The aim of the strategy is to improve all aspects of palliative care services including primary and community health, social services, hospitals, clinics and hospices.
Source: A Strategic Direction for Palliative Care Services in Wales, Welsh Assembly Government (029 2082 5111)
Links: Press release
Date: 2003-Feb
The Northern Ireland Executive set out its objectives for the health and personal social services in 2003-04.
Source: Priorities for Action 2003/2004: Planning priorities and actions for the health and personal social services, Northern Ireland Executive (028 9052 0500)
Links: Report (pdf) | Press release
Date: 2003-Feb
A report examined the need for 'assistive' technology and telecare (for example, alarms) for elderly and disabled people; discussed the emerging policy environment; identified new generations of telecare equipment and provision; and made recommendations for future development and deployment.
Source: David Bradley, Simon Brownsell and Jeremy Porteus, Assistive Technology and Telecare: Forging solutions for independent living, Policy Press, available from Marston Book Services (01235 465500)
Links: Summary
Date: 2003-Jan
A new book examined health service choice, focusing in particular on the 'QALY' (cost per quality-adjusted-life-year) measure.
Source: Douglas McCulloch, Valuing Health in Practice: Priorities, QALYs, and Choice, Ashgate Publications (01235 827730)
Links: Summary
Date: 2003-Jan
The Health (Wales) Bill had its third reading. The Bill gives a new role to reformed community health councils.
Source: Health (Wales) Bill (2002), Wales Office, TSO (0870 600 5522) | House of Commons Hansard, Debate 9.1.03, columns 334-373, TSO
Links: Text of Bill | Hansard
Date: 2003-Jan
