A new book examined the practical ways in which change in health services could be promoted. It included descriptions of all of the most important approaches to change being used in the National Health Service, discussion of when they worked best, and details of the evidence of their impact.
Source: Edward Peck (ed.), Organisational Development in Healthcare: Approaches, innovations, achievements, Radcliffe Medical Press (01235 528820)
Links: Summary
Date: 2004-Dec
The health service ombudsman highlighted the problems faced by disabled and elderly people in accessing National Health Service funding for long-term care. She called for national guidelines to assess eligibility for long-term care funding, in order to end the 'hit and miss' process that people faced.
Source: NHS Funding for Long Term Care: Follow up report, HC 144 (2004-2005), Health Service Ombudsman for England, TSO (0870 600 5522)
Links: Report (pdf) | Ombudsman press release | Guardian report | Community Care report
Date: 2004-Dec
A report summarized progress by Strategic Health Authorities in establishing an integrated set of eligibility criteria for National Health Service continuing healthcare, and in reviewing cases where people might have been denied continuing care. The government announced that it had commissioned a new national framework for assessing fully funded NHS continuing care.
Source: Melanie Henwood, Continuing Health Care: Review, revision and restitution, Department of Health (08701 555455) | Press release 9 December 2004, Department of Health (020 7210 4850)
Links: Summary (pdf) | DH press release | NHS Ombudsman press release | Alzheimer's Society press release | Community Care report
Date: 2004-Dec
The government published a three-year programme of action, at both national and local level, to improve access to the information which people needed (both general and personalized) in order to exercise choices about their personal health and healthcare.
Source: Better Information, Better Choices, Better Health: Putting information at the centre of health, Department of Health (08701 555455)
Links: Report (pdf)
Date: 2004-Dec
A survey found that demand for private hospital treatment in 2003 grew at its lowest rate for six years.
Source: Healthcare Market Review 2004-2005, Laing & Buisson (020 7833 9123)
Links: L&B press release
Date: 2004-Dec
A report examined the early implementation of 35 children's trust pathfinders (bringing together local child health, education and social services). It found that pathfinders varied substantially: but many had emphasized the importance of young people's input from the outset.
Source: Children's Trusts: Developing integrated services for children in England - Phase 1 Interim Report, National Evaluation of Children s Trusts/University of East Anglia (01603 593626)
Links: Report (pdf) | Summary (Word file) | Children Now report
Date: 2004-Dec
The government began consultation on the level of National Health Service funding for nursing care to apply from 1 April 2005. For eligible care home residents, the high band would increase from 125 to 129 per week; the medium band from 77.50 to 80 per week; and the low band would remain at 40 per week. (The three bands are based on the level of an individual s need.)
Source: Proposed Changes to Residential Care Charges from 4 April 2005, Department of Health (08701 555455)
Links: Consultation document (pdf) | DH press release
Date: 2004-Dec
The government announced detailed plans for implementing a reduction in the number of arm's-length bodies in the National Health Service - including scrapping the NHS Modernisation Agency.
Source: House of Commons Hansard, Written Ministerial Statement 30 November 2004, columns 24-27WS, TSO (0870 600 5522)
Links: Hansard | Guardian report
Date: 2004-Nov
Measures were announced to help make the Medicines and Healthcare Products Regulatory Authority operate more openly and transparently. A draft revised code of practice would ban the chair and members of advisory bodies established under the Medicines Act 1968 from holding interests in the pharmaceutical industry. Two lay representatives would sit on the committee of each body, as well as patient representatives on every expert advisory group, to give patients a greater involvement in the regulation of medicines, and monitoring their safety.
Source: Review of the Code of Practice on Interests to Apply to the Chairmen and Members of the Advisory Bodies Established under the Medicines Act 1968, Medicines and Healthcare Products Regulatory Agency (020 7084 2406)
Links: Consultation document (pdf) | MHRA press release | Guardian report
Date: 2004-Nov
A new book examined how health and social care agencies worked together effectively to deliver services.
Source: Ros Carnwell and Alex Carson, Effective Practice in Health and Social Care, Open University Press (01280 823388)
Links: Summary
Date: 2004-Nov
A think-tank report said that the government s approach to helping older people with long-term health conditions stay out of hospital was welcome: but the National Health Service should proceed with caution in introducing new case management initiatives, since evidence on their effectiveness was weak.
Source: Ruth Hutt, Rebecca Rosen and Janet McCauley, Case-Managing Long-Term Conditions: What impact does it have in the treatment of older people?, King s Fund (020 7307 2591)
Links: Report (pdf) | KF press release
Date: 2004-Nov
An article said that some hospitals would face sizeable changes to their incomes under a new National Health Service payment system. The new system would provide a more accurate method of calculating payments than using finished consultant episodes, and would avoid the problem of episode inflation: but it would also give rise to considerable upheaval for some acute providers. (Under the new system, providers would be paid for the actual activity that they undertook, instead of being commissioned through block contracts.)
Source: Paul Aylin, Susan Williams, Alex Bottle and Brian Jarman, 'Counting hospital activity: spells or episodes?', British Medical Journal, 20 November 2004
Links: Article | BMJ press release | Guardian report
Date: 2004-Nov
A new book explored the concepts of trust, control and risk-management as key components of organizational accountability in the public sector. It explored how the concept of risk management had been introduced into the public sector, and how this had impacted on the definition of governance in the National Health Service.
Source: Ellie Scrivens, Quality, Risk and Control in Health Care, Open University Press (01280 823388)
Links: Summary
Date: 2004-Nov
A report said that older people were healthier, more active and longer-lived than ever before, and were more likely to stop smoking and take advantage of health screening and immunization to stay healthy. But services needed to continue to improve and expand to meet the needs of an increasingly ageing population. A think tank warned that further progress could be hampered if funding were diverted from the intermediate care services (that had greatly reduced delayed discharges) into new services for improving care for older people with long-term conditions.
Source: Better Health in Old Age, Department of Health (08701 555455) | Press release 2 November 2004, King s Fund (020 7307 2400)
Links: Report (pdf) | DH press release | King's Fund press release | CSP press release | Age Concern press release | Help the Aged press release | Guardian report
Date: 2004-Nov
A report said that accessing services provided by the full range of clinical professionals could be just as important in patient care as accessing a family doctor or nurse.
Source: Choice and Access to NHS Services: Accessing services provided by allied health professionals and primary care practitioners, NHS Alliance (01777 869080)
Links: NHS Alliance press release
Date: 2004-Oct
A think-tank report said that a systematic review was needed of the challenges and demands facing social care. A better conception of the relationship between social care and the National Health Service would help to promote an understanding of what it could achieve and the resources needed to deliver improvements.
Source: Deborah Roche and Jennifer Rankin, Who Cares?: Building the social care workforce, Institute for Public Policy Research, available from Central Books (0845 458 9911)
Links: Report (pdf) | IPPR press release
Date: 2004-Oct
The Welsh Assembly government began consultation on a national service framework for children, young people and maternity services. The framework set out a 10-year vision for developing high quality services and reducing inequalities in service delivery. It set standards for health and social services, as well as other areas that had an impact on the health and well-being of children and young people - including, education, housing, leisure and transport.
Source: National Service Framework for Children, Young People and Maternity Services in Wales, Welsh Assembly Government (029 2082 3657)
Links: Consultation document (pdf) | Consultation document (pdf links) | Wales NHS press release
Date: 2004-Oct
A report examined experiences of the hospital discharge system, focusing particularly on the effect of the reimbursement policy adopted by the government. It found insufficient focus on choices and opportunities for older people leaving hospital, with wide variations between one part of the country and the other. Fining councils for delayed discharges had almost halved the extra time that older people spent in hospital, but up to half of those patients were back in hospital within three months.
Source: Leaving Hospital: The price of delays, Commission for Social Care Inspection (0845 015 0120)
Links: Report (pdf) | CSCI press release | CDNA press release | Age Concern press release | Guardian report | Community Care report
Date: 2004-Oct
A research review aimed to identify initiatives to tackle delayed discharge in Scotland, and set this information in the context of existing policy and evidence on the nature and extent of problem.
Source: Gill Hubbard, Guro Huby, Sally Wyke and Markus Themessl-Huber, Research Review on Tackling Delayed Discharge, Scottish Executive (web publication only)
Date: 2004-Oct
A new 'strategic agreement' was announced between the Department of Health, the National Health Service and the voluntary and community sector, giving charities and the voluntary sector a bigger role in delivering NHS and social services.
Source: Making Partnership Work for Patients, Carers and Service Users, Department of Health (08701 555455)
Links: Agreement (pdf) | DH press release | Guardian report
Date: 2004-Sep
The government responded to a report by a committee of MPs on palliative care.
Source: Government Response to House of Commons Health Committee Report on Palliative Care Fourth Report of Session 2003-04, Cm 6327, Department of Health, TSO (0870 600 5522)
Links: Response (pdf) | MPs report
Date: 2004-Sep
A coalition of 20 charities and patient groups launched a manifesto aimed at securing better care for the 17 million people living with long-term chronic conditions. The manifesto called for a shift in focus away from emergency care and waiting lists, towards the care and support of those with long-term conditions.
Source: 17 Million Reasons: Improving the lives of people with long-term conditions, NHS Confederation (020 7959 7272) and 19 other organizations
Links: Manifesto (pdf) | NHS Confederation press release | Guardian report
Date: 2004-Sep
A report highlighted practice that had been found to work well in health and social care services for older people. Topics included reimbursement, commissioning, discharge planning and partnership working.
Source: Changing Times: Improving services for older people - Report on the work of the Health and Social Care Change Agent Team 2003/04, Department of Health (08701 555455)
Links: Report (pdf)
Date: 2004-Sep
The government published a national service framework for children, young people and maternity services, designed to ensure that all children and young people received health and social care services that were age-appropriate and accessible, and recognized their needs as different.
Source: National Service Framework for Children, Young People and Maternity Services, Department of Health (08701 555455)
Links: Framework (pdf links) | Summary (pdf) | DH press release | HDA press release | Healthcare Commission press release | NHS Confederation press release | RCPsych press release | CSCI press release | ADSS press release | NYA press release | Guardian report | Community Care report
Date: 2004-Sep
A report sought to provide scientific advice on implementation issues arising out of a review of the allocation of resources to local health boards in Wales. In particular, it examined whether specific urban and rural factors resulted in unavoidable additional costs when providing health services in such areas, and whether the resource allocation formula should be adjusted accordingly.
Source: David Gordon et al., Targeting Poor Health: Review of rural and urban factors affecting the costs of health services and other implementation issues, Welsh Assembly Government (029 2082 5111)
Links: Report (pdf)
Date: 2004-Aug
A report by a committee of MPs said that there was a wide range of inequities in the provision of palliative services. There was inequity by geographical area, where need and provision were not well matched; inequity by patient group, with particular problems in services dealing with patients in transition from children's to adult services, older people, patients with complex needs, and patients from black and minority ethnic communities; and most fundamentally, inequity by disease group.
Source: Palliative Care, Fourth Report (Session 2003-04), HC 454-I, House of Commons Health Select Committee, TSO (0870 600 5522)
Links: Report | Help the Aged press release | Guardian report | Community Care report
Date: 2004-Jul
The government announced details of proposed changes in arm's-length bodies in the National Health Service, including the abolition and merger of a number of bodies.
Source: Reconfiguring the Department of Health's Arm's Length Bodies, Department of Health (08701 555455) | House of Commons Hansard, Written Ministerial Statement 22 July 2004, columns 73-77WS, TSO (0870 600 5522)
Links: Report (pdf) | Hansard | DH press release | CSCI press release | Guardian report
Date: 2004-Jul
A report said that the structure of private finance initiative projects in the National Health Service made it difficult to evaluate whether the 'risk premium' (extra spending in return for the carrying of risk by private contractors) was justified. The government s claim that the higher costs of private finance were due to risk transfer was 'largely unevaluated' for central government projects.
Source: Allyson Pollock, David Price and Stewart Player, Public Risk for Private Gain? The public audit implications of risk transfer and private finance, Unison (0845 355 0845)
Links: Report (pdf) | Guardian report
Date: 2004-Jul
A report said that the private finance initiative in the National Health Service had to be reformed if the full benefits for patients were to be realised. It put forward a reform plan, including: a more flexible PFI regime; ensuring bed numbers were based on robust assessments of local needs; reforming the appraisal model to support investment in good design; dramatically cutting red tape by streamlining the number of project reviews; and overhauling the bidding process to cut legal costs and make better use of scarce planning and design skills.
Source: Getting the Best out of Future Capital Investment in Health, NHS Confederation (020 7959 7272)
Links: NHS Confederation press release | Guardian report
Date: 2004-Jun
A report called for more joint working between primary and secondary care providers to achieve better chronic disease management for patients.
Source: Clinicians, Services and Commissioning in Chronic Disease Management in the NHS, Royal College of General Practitioners (020 7581 3232), Royal College of Physicians, and NHS Alliance
Links: Report (pdf) | RCGP press release
Date: 2004-Jun
A report highlighted ways in which local strategic partnerships could pool their resources in order to improve the health and well-being of local communities.
Source: Lucy Hamer, Pooling Resources Across Sectors: A report for local strategic partnerships, Health Development Agency (020 7430 0850)
Links: Report (pdf) | HDA press release
Date: 2004-Jun
The government launched the 'NHS Employers' Organisation' - an independent body which would have responsibility for a number of workforce issues. It would be run by the NHS Confederation (an existing body representing NHS organisations), and its main responsibilities would be to draw together NHS employers' views on how to implement NHS employment policy. Approximately 50 posts would be transferred from the Department of Health to the new organisation, dealing with national pay policy, disciplinary frameworks, recruitment campaigns, and employee communications.
Source: Press release 25 June 2004, Department of Health (020 7210 4850)
Links: DH press release
Date: 2004-Jun
A report said that, although devolution of control had been recognised as a key principle of healthcare reform, there remained a number of important unresolved issues which threatened to compromise the efficacy of local government as a key lever in the delivery of quality healthcare.
Source: Kevin Skinner (ed.), Community Leadership and Public Health: The role of local authorities, Smith Institute (020 7592 3618)
Links: Report (pdf)
Date: 2004-Jun
A think-tank report said that claims that the National Health Service had too many managers and administrators were not only untrue, they were also hugely damaging to the morale of NHS staff, and to the quality of the health debate.
Source: Nigel Edwards, Managers: Can the NHS manage without them?, Social Market Foundation (020 7222 7060)
Links: NHS Confederation press release
Date: 2004-May
Following a review, the government announced that by 2007-08 there would be a 50 per cent reduction in the number of 'arms length' bodies in the National Health Service, with an annual saving in expenditure of 0.5 billion.
Source: House of Commons Hansard, Written Ministerial Statement 20 May 2004, columns 61-64WS, TSO (0870 600 5522)
Links: Hansard | NHS Confederation press release | Guardian report
Date: 2004-May
Researchers sought to assess the feasibility of offering choice of referral pathway in general practice consultations to patients needing routine referral for surgery. They concluded that offering choice was feasible and would be welcomed by general practitioners and patients.
Source: Roger Taylor, Mike Pringle and Carol Coupland, Implications of Offering Patient Choice for Routine Adult Surgical Referrals, Department of Health (08701 555455)
Links: Report (pdf) | Summary (pdf)
Date: 2004-Apr
A report provided a summary of national policies and local action to improve patient access to health services.
Source: Lucy Hamer, Improving Patient Access to Health Services: National review and case studies of current approaches, Health Development Agency (020 7430 0850)
Links: Report (pdf)
Date: 2004-Apr
A report examined the scope for local strategic partnerships to use resources more flexibly to promote the well-being and health of local communities.
Source: Lucy Hamer, Pooling Resources Across Sectors: Report for local strategic partnerships, Health Development Agency (020 7430 0850)
Links: Report (pdf)
Date: 2004-Apr
A study sought to identify where in the country there were likely to be most constraints on choice for patients waiting over 6 months for elective care. For most of the population there was already a significant potential choice of hospitals. The number of available and unoccupied beds within 60 minutes travel time was lowest in the Scottish Borders, North Yorkshire, and parts of East Anglia, Lincolnshire, Devon and Cornwall. Adding in private facilities did not alter this pattern. Putting together demand with this supply, the number waiting over 6 months per bed within 60 minutes travel time was highest in the South East (except London), parts of the South West (Cornwall, Bristol), East Anglia and the Welsh Border.
Source: Mike Damiani, Jennifer Dixon and Carol Propper, Mapping Choice in the NHS: Analysis of routine data, Working paper 04/095, Centre for Market and Public Organisation/University of Bristol (0117 954 6943)
Links: Report (pdf)
Date: 2004-Mar
The Welsh Assembly decided to merge its health and social care departments. The new structure included directorates dealing with policy for older people and long-term care, and for children and families.
Source: Community Care report
Date: 2004-Mar
The government decided to abolish the National Health Service Modernisation Agency, following a review. The agency (set up in 2001 to raise NHS standards and spread best practice) would be replaced with a much smaller organisation which would continue the task of spreading best practice across the NHS, with a remit to nurture innovation.
Source: Statement, 10 March 2004, Department of Health (020 7210 4850)
Links: Statement | Guardian report
Date: 2004-Mar
The government began consultation on proposals for secondary legislation to deal with the financial failure of new National Health Service foundation trusts. The government would not guarantee the debts of an NHS Foundation Trust except in the specific case of a private finance initiative (PFI) contract.
Source: Consultation on Proposals for Secondary Legislation to be Made under the Health and Social Care (Community Health and Standards) Act 2003 to Establish a Failure Regime for NHS Foundation Trusts, Department of Health (08701 555455)
Links: Consultation document (pdf)
Date: 2004-Mar
The Northern Ireland Executive set out its priorities for health and social care services in 2004-05. It set 50 individual targets - including shorter waiting times for hospital services, more community support for vulnerable people, and more accessible primary care services. But a children's group reportedly warned that not enough money was being spent on preventative care and support services.
Source: Priorities for Action 2004/05: Planning priorities and actions for the health and personal social services, Department of Health, Social Services and Public Safety/Northern Ireland Executive (028 9052 8286) | Children Now, 24-30 March 2004
Links: Report (Word file) | NIE press release | Children Now article
Date: 2004-Mar
The government published a draft model contract between National Health Service foundation trusts and primary care trusts.
Source: ABC Primary Care Trust (1) and XYZ Foundation Trust (2): Terms and conditions for the provision of health services, Department of Health (08701 555455)
Links: Model contract (pdf)
Date: 2004-Feb
A report by a committee of MSPs reviewed the National Health Service Reform (Scotland) Bill. It said that the proposal to abolish NHS trusts in Scotland had been generally welcomed in evidence, but that more would need to be done to ensure effective joint working between NHS agencies.
Source: Stage 1 National Health Service Reform (Scotland) Bill, 3rd Report 2004, SP Paper 90, Scottish Parliament Health Committee, TSO (0870 606 5566)
Links: Report
Date: 2004-Feb
The Health Ombudsman reportedly upheld (in an unpublished decision) a complaint that a National Health Service trust, by denying nursing care support to someone caring for a sufferer from Alzheimer's Disease, had misapplied its local eligibility criteria and Department of Health guidance, and had used assessment tools biased towards physical conditions and against care at home.
Source: Community Care, 12 February 2004
Links: Community Care report | Guardian report
Date: 2004-Feb
The government announced that, from 27 February 2004, the National Health Service would be required to assess patients for fully funded continuing care before they left hospital. Care might be provided in a variety of settings including a nursing home, hospital, hospice or a person s own home. (The Health Ombudsman had previously reported that hospital assessment procedures were sometimes poorly organised.)
Source: Press release 27 February 2004, Department of Health (020 7210 4850) | The Continuing Care (National Health Service Responsibilities) Directions 2004, Department of Health, TSO (0870 600 5522) | The Delayed Discharges (Continuing Care) Directions 2004, Department of Health, TSO
Links: DH press release | Continuing care regulations (pdf) | Delayed discharge regulations (pdf) | Ombudsman report
Date: 2004-Feb
An article said that healthcare might soon be transformed by the introduction of new providers, including private organisations. These were introducing new ways of working, resulting in faster throughput and lower costs - with the result that the National Health Service and existing private providers were having to re-examine how they provided care.
Source: Penelope Dash, 'New providers in UK health care', British Medical Journal, 7 February 2004
Links: Article | BMJ press release
Date: 2004-Feb
A report identified the different approaches in England, Northern Ireland, Scotland and Wales to various combinations of markets, local communities, professionals and managers as models for the National Health Service.
Source: Scott Greer, Four Way Bet: How devolution has led to four different models for the NHS, Constitution Unit/University of London, available from Imprint Academic (01392 841600)
Links: Constitution Unit press release
Date: 2004-Feb
A report said that most older people's 'champions' (mostly inside the National Health Service or local councils) were highly committed to improving services for older people: but they were not always clear about what was expected of them, or how to influence or take the lead on change. (The report was published by a United Kingdom-wide partnership of voluntary agencies concerned with older people, supported by government.)
Source: Jill Manthorpe, Championing Older People: Making a difference - Findings from 209 older people s champions, Better Government for Older People (0870 770 3292)
Links: Report (pdf) | Summary (pdf) | Community Care report
Date: 2004-Feb
