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Transcript of NHS Timeline
Developments in Health
1990: NHS and Community Care Act
Internal market is introduced, which means health authorities manage their own budgets. Now health authorities will manage their own budgets and buy healthcare from hospitals and other health organisations. In order to be deemed a "provider" of such healthcare, organisations will become NHS Trusts, that is, independent organisations with their own managements.
Labour comes to power and publishes the White Paper, The new NHS: Modern, dependable. This aims to replace the internal market and GP fundholding with a more cooperative, integrated system while retaining the purchaser–provider split.
The consultation document, A first class service, leads to the creation of NICE and the Commission for Health Improvement. The two new organisations aim to provide guidance on the use of technology and how to strengthen quality.
A public inquiry is announced to understand the failings of the Bristol Royal Infirmary in providing care to children receiving cardiac surgical services. As a result of an increasing emphasis is placed on quality, with outcomes increasingly seen as important to contracting and the provision of care.
In an effort to generate better coordination between health authorities and local authorities, the NHS Reorganisation Act sees the traditional tripartite structure replaced by a unitary structure with 90 health authorities reporting to 14 regional health authorities. Under the reforms, regional, area and district heath authorities replace regional hospital boards, taking over public health and other services from local authorities in the process.
A winter of discontent: The NHS’ financial problems worsen during the winter of 1978–79 as a result of the oil crisis. Widespread strikes are prompted across Britain following attempts to impose a pay freeze to control inflation.
In response to the growing number of specialist registrars unable to secure consultant posts, a committee is set up to examine the supply of medical professionals.
The committee concludes that too many doctors are being trained and proposes a 12 per cent reduction. This is soon realised to be a misjudgment and in 1961 the Minister of Health is forced to increase the number of training places by 10 per cent.
Enoch Powell Minister of Health is an enthusiastic sponsor of the Hospital Plan. The objective is to remedy a decade of neglect, closing many hospitals and replacing them with new or extended facilities.
The uneven distribution of primary care services was a key problem at the formation of the NHS and successive surveys demonstrated that many areas were ‘under doctored’.
In 1950, the Ministry of Health commissions Sir Henry Cohen to undertake a wide-ranging review of general practice. This leads to the provision of interest-free loans to help GPs develop their practice premises as well as mechanisms to control the geographical distribution of GPs.
In February 1953, the Treasury requests an inquiry into the NHS and related expenditure, and the Guillebaud Committee is set up. The emphasis of the subsequent report is intended to be on preventing further increases in expenditure, rather than introducing cuts.
Interviewed by David Frost on television, Prime Minister Tony Blair commits to large and progressive increases in NHS funding. The NHS Plan outlines a strategy for more doctors, more nurses, more beds and 100 hospital building schemes by 2010, with improved access to hospitals and primary care and a renewed focus – through performance targets – on decreasing waiting times.
2002: NHS reorganisation
District health authorities are replaced by strategic health authorities (SHAs) and primary care trusts (PCTs). Primary care trusts are set up to improve the administration and delivery of healthcare at a local level.
The primary care trusts oversee 29,000 GPs and 21,000 NHS dentists. Primary care trusts that are in charge of vaccination administration and control of epidemics also control 80 per cent of the total NHS budget. They also liaise with the private sector when contracting out of services is required. As local organisations, they are best positioned to understand the needs of their community, so they can make sure that the organisations providing health and social care services are working effectively.
While the concept of practice based commissioning had been outlined in the 1998 White Paper, The new NHS, and in the NHS Improvement Plan in June 2004, this paper outlines in more detail how those GP practices wishing to do so will be given indicative commissioning budgets. The reforms are announced as part of the Government’s plans to devolve responsibility for commissioning services from PCTS to local GP practices.
2006: NHS reorganisation
Strategic health authorities (SHAs) are reduced from 28 to 10. The number of primary care trusts (PCTs) fall from 303 to 152.
The right to medical treatment for everyone under a new national health service is proposed by an inter-departmental committee led by Sir William Beveridge.
Anuerin Bevan is made Minster for Health following the 1945 General Election.
The National Health Service Act is published.
The Coalition government is formed. After eight years as Shadow Secretary of State for Health, Andrew Lansley is appointed to the Cabinet. Among many pledges on health, the Coalition Agreement promises “no more top-down reorganisations of the NHS”.
2011 (Jan): NHS reorganisation
The Health and Social Care Bill 2010/11 proposes significant reforms to increase the influence of GPs on commissioning, increase competition and abolish strategic health authorities (SHAs) and primary care trusts (PCTs).
Increasing opposition to the Health and Social Care Bill leads the Prime Minister to ‘pause’ and initiate a ‘Listening Exercise’ led by the NHS Future Forum, an independent expert group. The Forum considers
Modifications to the Bill.
Following nearly 18 months and thousands of amendments, the Health and Social Care Bill is passed. Last-minute attempts to derail the Health and Social Care Bill are defeated as the Bill is passed. Medical leaders passionately opposed to the Bill urge GPs to limit the ‘worst effects’ of the legislation, while the Labour Party pledges to repeal the Bill if re-elected.
The area tier of NHS management is abolished, resulting in 192 district health authorities (DHAs) that are responsible to the regional health authorities. The aim is to simplify the structure. However, this was to be the start of many future reorganisations of health authorities over the next three decades.
Prime Minister Margaret Thatcher makes the surprise announcement of an NHS review on the television programme Panorama.
The new arrangements heralded by the Health and Social Care Act 2012 will come into being from 1 April 2013.
Strategic health authorities and primary care trusts (PCTs) will be formally abolished. Responsibility for commissioning most hospital and community services passes to those clinical commissioning groups (CCGs) that have been authorised by the new NHS Commissioning Board, with the latter taking on its full functions.
Local authorities will officially take control of public health, with directors of public health being transferred from the NHS to local government. Oral health promotion responsibilities will move to local authorities.
The public health strategy proposes a new organisation – Public Health England – whose sole responsibility would be to provide advice and influence public health issues. Crucially, it also entails the return of public health back to local authorities, after more than two decades as a subset of the NHS. Public Health England, a new body located within the Department of Health, will lead on public health at the national level. Dental public health will lie with Public Health England.
Health Education England is set to take over strategic health authorities’ (SHAs’) responsibilities for education and training.
Professor Sir (soon to become Lord) Darzi leads a major review of the NHS to outline a 10-year vision for its future. Lord Darzi’s vision includes major reconfiguration of hospital services, driven by quality and the clinical realities of where care is best delivered. Centralising specialist services is a major theme, while polyclinics (large community facilities providing a much wider range of services than is offered by most GP practices) are proposed.
The CQC, a new independent regulator of all health and social care services in England, is created following the merger of three regulators: the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission. The CQC takes on responsibility for regulating and inspecting health and social care services in England, including services provided by the NHS, local authorities, private companies and voluntary organisations.
Sir David Nicholson, writing in his 2008/09 annual report, sets the scene for future efficiency savings by warning the NHS to plan “on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014 – between £15 billion and £20 billion across the service over the three years”. This figure is widely cited in subsequent debates and discussions.
2000: NHS walk-in centres
New health facilities open offering convenient access, round-the-clock, 365 days a year
2003: White Paper, Choosing Health
The public health White Paper, Choosing health, reiterates the agenda to promote individual responsibility with a focus on issues such as smoking, obesity, diet and nutrition, exercise and sexual health.
The White Paper supports individual choice, personalised services and coordinated working between the public and private sectors.
2007: Smoking ban
A smoking ban in England comes into effect, following similar measures that had already been introduced in Scotland in March 2006, Wales in April 2007 and Northern Ireland in April 2007.
2008: Free choice is introduced
Free choice is introduced on April 1 2008. Patients can choose from any hospital or clinic that meets NHS standards.
1991: First NHS Trusts established
Fifty-seven NHS trusts are established to make the service more responsive to the user at a local level.
1992: The White Paper
The White Paper identifies coronary heart disease (CHD), cancer, mental health, AIDS/HIV and sexual health, and accidents, as five key areas for improvement. There is also some emphasis on individual responsibility for health.
1994: NHS Organ Donor Register
National register for organ donation is set up to co-ordinate supply and demand after a five-year campaign
1998:NHS Direct launches
A nurse-led advice service provides people with 24-hour health advice over the phone.
1980: MRI scans introduced
Using a combination of magnetism and radio frequency waves, MRI scanners provide information about the body.
1980: Keyhole surgery
A surgeon uses a telescopic rod with fibre optic cable to remove gallbladder.
1980: Black Report
Commissioned three years earlier by David Ennals the report aimed to investigate the inequalities of healthcare. The report aimed to investigate the inequality of healthcare that still existed despite the foundation of the NHS i.e. differences between the social classes in the usage of medical services, infant mortality rates and life expectancy. It finds that poor people are still more likely to die earlier than rich ones. The Whitehead Report in 1987 and the Acheson report in 1998 reached the same conclusions as the Black Report.
1986:Aids health campaign
The government launches biggest public health campaign in history to educate people about the threat of Aids as a result of HIV.
1987: Heart, lung and liver transplant
First heart, lung, and liver transplant is carried out at Papworth Hospital.
1988: Breast screening is introduced
Comprehensive national breast-screening programme introduced.
1978: First test-tube baby
Louise Brown is the world’s first baby to be born as a result of in-vitro fertilization.
1979: Bone marrow transplant
The first successful bone marrow transplant on a child takes place.
1960: First kidney transplant
An Edinburgh doctor, Michael Woodruff, performs the first UK transplant involving an identical set of twins.
1961: The Pill made available
The contraceptive pill is made widely available and is hailed as a breakthrough of the 20th Century.
1962: First hip replacement
Professor John Charnley in Wrightington Hospital carries out first full hip replacement.
1967: Abortion Act
The Abortion Act is introduced by Liberal MP David Steel and is passed on a free vote, becoming law on April 27 1968.
1968:First NHS heart transplant
A 45-year-old man becomes the first Briton to have a heart transplant on 3 May.
1953: DNA structure revealed
Crick and Watson, two Cambridge scientists, reveal the structure of DNA in Nature Magazine.
1954: Smoking-cancer link established
Sir Richard Doll establishes a clear link between smoking and lung cancer.
1958: Polio and diphtheria vaccinations
A programme to vaccinate everyone under the age of 15 against polio and diphtheria is launched. One of the primary aims of the NHS is to promote good health, not simply to treat illness, and the introduction of the polio and diphtheria vaccine is a key part of the NHS’s public health plans.