History of NHS – 2000-present day
The 2000s. NHS Targets (NHS Plan 2000) and Scandals
Key events: NHS Plan further developed the Internal Market and formalised targets. One major and two minor NHS reorganisations. 3 major scandals (Bristol, Shipman and Alder Hey). Congestion charge and smoking arguably most influential measures. A lot else happened in this decade.
- Internal market adapted
- NHS Plan, and targets were introduced, and some services outsourced to the private sector
- Walk-in Centres
- Health Development Agency (HDA) (later absorbed into NICE)
- Dr Foster
- Bristol, Shipman and Alder Hey scandals
- PCGs become PCTs
- SARS-Coronavirus
- Foundation Trusts (encouraging financial independence)/Payment by Results (PbR)
- Monitor (later NHS Improvement)
- Targets (4 hours, 18 weeks)
- Healthcare Commission (later CQC)
- GPs partly paid by QoF points
- Health Protection Agency (HPA) (later Pubic Health England)
- ‘Choice’ agenda, and Choose and Book
- Mental Capacity Act (MCA) and IAPTs
- NHS Constitution.
2000. Management. The NHS Plan: A plan for investment. A plan for reform. The ten-year plan for the NHS in England combined a commitment to substantial investment with radical changes. The most controversial aspects of the plan were a major Private Finance Initiative (PFI) hospital building programme; and the introduction of more private sector providers, cementing the competitive internal market.
The plan stated that: “by 2004 no-one should be waiting more than four hours in accident and emergency from arrival to admission, transfer or discharge”. It has not been achieved since July 2015. There was also a focus on elective care (operations, etc).
In 2004 this crystallised into the ambition to reduce waiting times from ‘18 months to 18 weeks’. By December 2008, waiting times for elective care had fallen substantially: 90.3% of admitted and 96.8% of non-admitted patients were seen within 18 weeks. In October 2021, it is 65.6% in England.
2000. Management. 10-year NHS Cancer Plan and Two-Week Cancer Target. Following the introduction in 1999 of a maximum two week wait for a specialist appointment for cases of suspected breast cancer, the Cancer Plan announced this would be rolled out for all cancers by December 2000 – now a right under the NHS Constitution. The plan built on existing cancer initiatives, providing a comprehensive strategy across the whole patient pathway, establishing 34 local cancer networks in England.
2000. Clinical. NHS ‘Walk-in Centres’. In April 1999, DHSC authorised funding for a pilot scheme of 40 NHS walk-in centres in England, the first of which opened in London in January 2000.
2000. Public Health. Health Development Agency (HDA). Following its announcement in the 1999 ‘Saving Lives: our Healthier Nation’ White Paper, the Health Development Agency (HDA) was created as a successor ‘special health authority’ to the Health Education Council (1969-1987) and the Health Education Authority (1987-2000). Its purpose was to develop an evidence base to improve health and reduce health inequalities in partnership across a range of sectors.
The functions of the HDA were transferred to NICE in 2005.
2000. Information Technology. The Dr Foster unit started at Imperial College (London) monitoring the performance of the NHS and providing information to the public.
2000. Public Health. BSE outbreak: inquiry report. The report of an inquiry into the emergence of – and response to – BSE in cattle and vCJD in humans criticised the way the government handled the crisis.
2000. Scandal. The Shipman Inquiry in 2005 reported on the serial killer and GP Harold Shipman. Shipman was found guilty of 15 murders in January 2000 (later thought to be approximately 250 murders). It led to the GMC creating a compulsory yearly ‘appraisal’ and 5 yearly ‘revalidation’ for all senior doctors in the UK.
2001 Labour Government (Tony Blair MP)
2001 World Population reaches 7 Billion
2001 ‘9/11’ Attack on the World Trade Center – September 11th
2001 USA invades Afghanistan and topples the Taliban regime – October 7th
2001. Management. NHS Reorganisation (Major). Health and Social Care Act 2001. Enacted the NHS Plan 2000. Primary Care Trusts (PCTs) started forming out of Primary Care Groups (PCGs) with the remit of commissioning primary, community and secondary health services. Collectively the 303 PCTs spent around 80 per cent of the NHS budget.
They were abolished in April 2013 as part of the Health and Social Care (HSC) Act 2012, being replaced by Clinical Commissioning Groups (CCGs).
The 95 Health Authorities became 28 Strategic Health Authorities (SHAs) with a sub-regional role.
2001. Public Health. The Health Select Committee Report on Public Health found blurred lines of responsibility between health and local government.
2001. Public Health. The Food Standards Agency (FSA) was created taking responsibility for food hygiene and nutritional policy.
2001. Regulation. Nursing and Midwifery Order 2001 established the Nursing and Midwifery Council as the nursing and midwifery regulator, taking over from the UKCC.
2001. Scandal. The Bristol Inquiry chaired by Professor Ian Kennedy QC concluded the Bristol Royal Infirmary were ‘simply not up to the task’ because of shortages of senior surgeons (consultants and registrars) and nurses, and a lack of leadership, accountability, and teamwork.
2001. Management. National service framework for older people. The framework outlined eight standards to govern older people’s services, including eliminating age discrimination and promoting person-centred care.
2001. Management. Performance rating for acute trusts. Zero-three stars were assigned to an organisation, based on delivery of national targets and overall performance.
2001. Government. ‘Shifting the balance of power within the NHS’ white paper. The pervading theme of which was the devolution of responsibilities to frontline staff and communities.
2001. Management. NHS Performance Assessment Framework(PAF) was established with the aim of delivering a broader view of performance in the NHS. CHECK
2001. Information Technology. NHS Information Authority (NHSIA) (Establishment and Constitution) Order 1999 brought together four NHS IT and Information bodies in England. It became part of Health and Social Care Information Centre (HSCIC) in 2005. CHECK
2002. Management. NHS Reorganisation (Minor). The NHS Executive was divided into 4 Regional Directorates, themselves abolished in 2003; as the 28 SHAs (formed in 2001) had taken over the sub-regional remit.
2002. Epidemic. Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) outbreak. Thought to have originated from bats and spread to other animals (civet cats). There were 774 deaths. This was not bad enough to herald what was to come with COVID-19.
2002. Public Health. The ‘Getting ahead of the curve – A strategy for combating infectious diseases’ strategy document proposed to establish a new National Infection Control and Health Protection Agency (the latter was formed in 2003).
2002. Management. Foundation Trust system, was announced, to liberate the best hospitals from central governmental control and encourage them to compete to provide better care.
2002. Management. ‘Delivering the NHS Plan: next steps on investment, next steps on reform‘. The government outlined progress against the NHS plan and introduced the concept of ‘Payment by Results (PbR)’ for acute, elective activity in the document. This was a key step in introducing the market to the NHS. As from then on, hospitals could be paid for what they do – linking NHS funding to population growth. This encourages expansion, and looking for new work; but with the inherent difficulty of uncontrolled spending.
2002. Clinical. First successful gene therapy. This was carried out at Great Ormond Street Hospital, London, curing 18-month-old Rhys Evans of severe combined immunodeficiency (SCID).
2002. Regulation. National Health Service Reform and Health Care Professions Act 2002. It legislated for recommendations made in light of the Bristol inquiry and government proposals in the 2001 document ‘Shifting the balance of power within the NHS’.
2002. Public Health. Food Standards Agency Act 1999. The aim of the agency was to would promote high standards throughout the food chain, from the point of production to the point of consumption. CHECK
2003. Public Health. The Health Protection Agency (HPA) was set up as a special health authority to protect people against infectious diseases and prevent harm from industrial incidents. Later absorbed into Public Health England.
2003. Public Health. Community Health Councils (CHCs) abolished, as part of the NHS Plan 2000; and were replaced, in England, by Public and Patient Involvement Forums, subsequently replaced by local involvement networks (LINks), themselves superseded by Healthwatch England in 2013.
2003. Regulation. Medicines and Healthcare Products Agency (MHRA) established, from a merger of the Medicines Control Agency (MCA) and the Medical Devices Agency (MDA); responsible for ensuring medicines and medical devices work and are acceptably safe. In April 2013, the MHRA merged with the National Institute for Biological Standards and Control (NIBSC) which became a ‘centre’ within it.
2003. Public Health. The ‘5-a-day’ Campaign was launched to encourage people to eat more fruit and vegetables.
2003. Public Health. Focus on Homelessness. The 2002 Rough Sleepers Unit target to reduce the number of people sleeping rough by two-thirds was met a year earlier than planned.
2003. Management/Integration. The Community Care (Delayed Discharges) Act 2003. The Act required local authorities to pay health care providers if they were responsible for the delayed discharge of an NHS patient from that provider. Even though a good idea, it had a limited effect on hospital discharges.
2003. Education. Physician Associates. PAs, medically trained generalist healthcare professionals, who work alongside doctors under defined levels of supervision, were formally introduced to the NHS. PAs are currently regulated by the Faculty of Physician Associates with the GMC expected to take on regulation.
2003. Management. Health and Social Care (Community Health and Standards) Act 2003. This provided for the establishment of NHS foundation trusts (FTs) (a new form of NHS organisation with greater freedoms) and a new independent regulator (later known as Monitor). Monitor merged with the Trust Development Agency (TDA) in 2016 to form NHS Improvement.
2003. Public Health. Congestion Charge. London. £5 a day.
2003. Management. National Service Frameworks (NSFs). These 10-year plans for chronic conditions which included an NSF were issued for mental health in 1999, and for coronary heart disease in 2000. Experienced clinicians advised the Chief Medical Officer (CMO), becoming Health Directors, or ‘tsars’, driving clinical policies for cancer, heart disease, mental health, and older people’s services. NSFs were discontinued in 2013. CHECK
2004 Boxing Day Tsunami occurs in Indian Ocean, leading to the deaths of 230,000
2004. Management. First Foundation Trusts (10).
2004. Management. Four-Hour A&E Target started. It was, and remains, the primary performance indicator for emergency care in the NHS, being modified from 100% to 98% in 2004 to allow ‘clinical exceptions’, e.g. patients undergoing active resuscitation. The target was reduced to 95% in 2010.
2004. Management. 18 Week Referral to Treatment (RTT) Target commenced and remains the primary performance indicator for planned care.
2004. Inspection. The Healthcare Commission, with the legal name of ‘The Commission for Healthcare Audit and Inspection’ (CHAI), was created by a parliamentary act in 2003, and took over the role of the Commission for Health Improvement (CHI) in 2004.
It also assumed some of the responsibilities of the National Care Standards Commission (NCSC) and the Audit Commission. The Commission was abolished on 31 March 2009 and its responsibilities in England broadly subsumed by the CQC.
2004. Management. Quality and Outcomes Framework (QoF). The reformulated GP contract put an increased emphasis on performance-related pay particularly in relation to the management of chronic disease.
2004. Clinical. First Daily Acute Medical (Outpatient) Clinic (AMC) in UK (in Coventry). AMCs later became known as Ambulatory Emergency Clinics (AECs) or Ambulatory Emergency Care Units (AECUs) and are now being renamed as Same Day Emergency Clinics (SDECs).
2004. Scandal. Alder Hey, leading to Human Tissue Act 2004. The Alder Hey organ scandal involved the unauthorised removal, retention, and disposal of human tissue, including childrens’ organs, between 1988 and 1995. The Act now regulates these activities including prohibiting the sale of human organs.
2004. Public Health. Health Protection Agency (HPA) was set up to protect the public in England from infectious diseases and environmental hazards. On 1 April 2013, it was subsumed by Public Health England.
2004. Management. ‘Choose and Book’ software. This went live in July 2004. The NHS Plan in 2000 committed to introducing electronic booking of appointments for patient treatment by 2005.
The scope of the project was later expanded to facilitate patient choice. ‘Choose and book’ allowed patients to book appointments electronically and to select a choice of place (initially up to four providers), time and date for a first appointment.
2004. Employment. NHS Employers was established to negotiate with unions on behalf of employers in the NHS.
2004. Management. ‘Agenda for Change‘ (AfC) single pay system came into operation in the NHS. It applied to all directly employed NHS staff, with the exception of medical staff, dentists and very senior managers.
2004. Management/Infection Control. MRSA infection reduction targets. Hospitals would be expected to halve MRSA (methicillin-resistant Staphylococcus aureus) infections by 2008 and demonstrate significant improvement year on year.
In 2007, a further target was set for a 30% reduction in the number of cases of C.difficile reported in 2010/11. These were the first targets that helped to improve the NHS’ performance against ‘superbugs’.
2005 Labour Government (Tony Blair MP/Gordon Brown MP)
2005 ‘7/7’ Attack on London Underground
2005. Management. Three of the four Standing Advisory Committees were abolished by the NHS (Standing Advisory Committees) Amendment Order 2005. Why this did not include the dental committee – which was abolished five years later, in 2010 – is unclear.
2005. Information Technology. The Health and Social Care Information Centre (HSCIC) was created by merging parts of the NHSIA and the Prescribing Support Unit. It was part of the DH Informatics Directorate, with the role of maintaining and developing the NHS IT infrastructure.
The NHS agency Connecting for Health (CfH) was also formed out of the disassembling of NHSIA. This adopted the responsibility of delivering the NHS National Programme for IT (NPfIT); an initiative to move the NHS in England towards a single, centrally mandated electronic care record connecting GPs to hospitals. In 2013, NHS CfH was disbanded, and some responsibilities taken over by HSCIC.
2005. Regulation. NHS Blood and Transplant was established to take over the responsibilities of UK Transplant (Organ Donation and Transplantation) and the National Blood Service (Blood Donation).
2005. Mental Health/Capacity. The landmark Mental Capacity Act 2005 provided a statutory framework for actions on behalf of adults who lack mental capacity.
2005. Public Health. ‘Scores on the Doors’ Food Hygiene Ratings became part of food hygiene information collected by Local Authorities.
2006. Management. ‘Patient Choice’ gave patients the choice of four hospitals, ending the tradition of being referred to the local hospital by your GP.
2006. Management. NHS Reorganisation (Minor). The 28 sub-regional SHAs were reduced to 10 regions. The current arbitrary 7 regions of NHSE are the descendants of the ‘original’ 1948 fourteen Regional Health Boards, via these 10 regions in 2006 (and other regions at other stages of NHS history).
2006. Public Health. Bowel Cancer Screening Programme (BCSP) invited people aged 60-69 years to use a home screening kit.
2006. Public Health. NHS Health Act 2006 saw smoking in workplaces and enclosed public spaces made illegal; in Scotland in March 2006, in Wales and Northern Ireland in April 2007, and in England in July 2007. Along with the seat-belt law (1983), this is one of the most important public health measures of all time. The Act also encompassed Forensic Mental Healthcare and created the NHS Counter Fraud Authority. There were also significant provisions relating to the integration of health and social care services
2006. Management/Specialised Services. Carter Review. The government commissioned an independent review in October 2005 that considered the processes by which specialised health services were commissioned. It was published in May 2006, making recommendations for improvement.
2007. Public Health. Junk Food Advertising Banned during children’s TV programmes. In February 2019, a similar ban across the Transport for London network came into force.
2007. Public Health/Management. ‘A Framework for Action‘. Professor Sir Ara Darzi carried out a review of London’s healthcare. The report outlined the case for change, highlighting the fact that London experienced big inequalities in health and healthcare, with significant disparities of life expectancy between richer and poorer areas. His proposed service model included the introduction of polyclinics (GP-run centres offering expanded services).
2007. Information Technology. ‘NHS Choices’ health information website launched. It was integrated with the NHS Direct website and since then – as the NHS website – has been the principle one for NHS health advice in England.
2008 Barack Obama elected to become the first black President of the USA
2008. Public Health. Abdominal aortic screening was introduced and offered to men in their 65th year.
2008. Mental Health. The Improving Access to Psychological Therapies (IAPT) Programme was set up to make it easier to access talking therapy on the NHS for people suffering from depression and anxiety disorders.
2008. Management. ‘High-Quality Care for All: the NHS Next Stage‘ (Darzi) Review intended to shift the emphasis of the NHS from increasing the quantity of care to improving its clinical quality. Patients’ rights and responsibilities were to be set out in a new NHS Constitution. A workforce strategy was intended to improve the skills and career progression of staff. NHS Evidence, a database within NICE, was also established.
2008. Public Health. Human Papillomavirus HPV Vaccination for Girls aged 12-13 years was introduced. This has since been offered to boys from 2019.
2008. Inspection. The Health and Social Care Act 2008 established the Care Quality Commission (CQC) as a new independent regulator, which would span both health and social care; evolving out of the Health Commission.
2008. Management. ‘Any willing provider’ commissioning. Patients were given the right to choose from any NHS-funded provider following a referral for routine-elective hospital services.
2009. Pandemic. Swine Flu. This was the second of two pandemics involving H1N1 influenza virus (the first being the 1918-1920 Spanish Flu pandemic). It is estimated to have caused 150,000 to 575,000 deaths globally.
2009. Management. Mixed-sex Hospital Accommodation ended.
2009. Management. NHS Constitution set out the enduring character of the NHS as comprehensive and equitable; and empowered staff and the public to know and exercise their rights to help drive improvements. The 4 Hour A&E, 18 Week Outpatient Referral and 2 Week Cancer NHS targets were added as rights in March 2010.
2009. Public Health. The Stroke Act F.A.S.T. (‘Face, Arm, Speech, Time’) campaign was launched.
2009. Public Health. NHS Health Checks began, with the aim of assessing and reducing the risk of heart disease, stroke, type 2 diabetes and kidney disease in individuals between 40 and 74 years who haven’t already been diagnosed with a long-term condition.
2009. Public Health. ‘Change4life’ campaign. As pledged in ‘Healthy weight, healthy lives: a cross government strategy for England’, the government launched the Change4Life campaign to tackle rising rates of obesity.
2009. Management. Quality, Innovation, Productivity and Prevention (QIPP) programme. Sir David Nicholson, Chief Executive of the NHS, said the NHS would need to make efficiency savings of approximately 6% a year. The ‘Nicholson Challenge’ was formalised as the Quality, Innovation, Productivity and Prevention (QIPP) programme. The term is now used to mean ‘clinical governance’ rather than cost saving and efficiency improvement.
2009. Management. Cooperation and Competition Panel (CCP). The CCP was set up to investigate potential breaches of rules on cooperation and competition, and to make recommendations on resolving breaches.
The 2010s. Competition (Health and Social Care Act 2012) then Collaboration (5 and 10 year Plans)
Key events: Health and Social Care Act 2012 (Lansley Reforms) increased competition. Francis Report on Mid-Staffs scandal (2013). One major and three minor NHS reorganisations. 5 and 10 year NHS Plans (2014, 2019) encouraged collaboration over competition.
- ‘Lansley’ reforms, leading to NHS England and CCGs, and public health returning to local government
- Public Health England (PHE) (later UK-HSA)
- ‘Francis Report on Mid-Staffs scandal’ showed consequences of over-focus on targets
- MMR
- Health Education England (HEE)
- Health Research Authority (HRA)
- NHS Trust Development Agency (TDA) (later NHS Improvement)
- MERS-Coronavirus
- London Olympics
- Genome project
- 7DS programme and junior doctors’ strike
- Ebola showed dangers of viruses
- Mental health targets started
- Tobacco control
- Sustainability and Transformation Plans (STPs).
2010 Conservative Government (coalition with Liberal Democrats) (David Cameron MP)
2010 Largest oil spill in US history occurs in the Gulf of Mexico
2010. Government. ‘Equity and Excellence: Liberating the NHS’ white paper attempted to strengthen provision nationally establishing the NHS Commissioning Board (later NHS England) and the Public Health Service (later Public Health England); and locally establishing Health and Wellbeing Boards. A commitment to ‘GP Consortia’ and clinically-led commissioning was made. Middle-tier organisations, i.e. Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs), were to be abolished.
2010. Scandal. Mid Staffordshire NHS Foundation Trust: The Francis Report in 2013 found the poor care of patients and high death rates at Mid Staffordshire NHS Foundation Trust from 2010 onwards, were due to an NHS wide over-focus on targets.
2010. Scandal. Ruling on Dr Andrew Wakefield in MMR scare. The General Medical Council ruled that Dr Wakefield had acted dishonestly regarding his paper linking the MMR vaccination to autism.
2011 Osama bin Laden shot dead by United States Navy SEALs in Pakistan
2011. Government. Health and Social Care Bill 2011 gave effect to the policies in the ‘Equity and Excellence’ white paper.
2011. Social Care. Dilnot Report. The Commission for Funding of Care and Support, chaired by economist Andrew Dilnot, proposed a new system where means-tested support is extended but with a cap on the lifetime care costs that every individual can expect to pay. Dilnot concluded that the adult social care system was not fit for purpose and required more funding – both from individuals and the state – for it to be sustainable. The source of which is still a point of debate. The report further found that the system was confusing, unfair and unsustainable.
2011. Scandal. Winterbourne View scandal and government response. A BBC Panorama programme exposed serious failings at Winterbourne View care home. In response, the government set out new action to transform care for people with learning disabilities.
2011-2. Education/Research/Management. Three new arms lengths bodies formed: Health Education England (HEE), Health Research Authority (HRA) and NHS Trust Development Agency (TDA). The TDA was formed to monitor the performance and financial management of non-Foundation Trust hospitals, merging in 2016 with Monitor to form NHS Improvement.
2011 (April-June 2011). Government. NHS Modernisation: Listening Exercise and NHS Future Forum. The Bill included safeguards against cherry picking and price competition. GP Consortia become Clinical Commissioning Groups (CCGs), which were required to have governing bodies including at least one nurse and one specialist doctor. From June to September 2011 further scrutiny of the bill paved the way for the HSC Act 2012.
2011. Management. NHS Reorganisation (Minor). The 10 SHAs became 4 ‘SHA Clusters’: London, North of England, Midlands (including East of England), and South of England. These became the 4 Regions (later 7) of NHS England in 2013.
2011 Scandal. PIP Breast Implants. French government advised women in France with breast implants manufactured by Poly Implant Prothèse (PIP) to have their implants removed. The company was found to have been producing faulty implants that contained industrial silicone and were prone to bursting.
2012. Epidemic. There was an outbreak of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) derived from dromedary camels (probably transmitted via bats), in the Middle East; it had a 35% mortality rate and was followed by another outbreak in South Korea in 2015 – further pre-warnings for COVID-19.
2012 Summer Olympics hosted in London
2012. Sport. The grand Opening Ceremony of the London 2012 Olympic Games included a homage to the NHS.
2012. Public Health. 100,000 Genomes Project. Plans were announced to introduce DNA mapping for cancer patients and 190 ‘rare’ diseases, including many inherited heart conditions.
2012. Management. NHS Commissioning Board (later NHS England). This independent body was established to review and assess the authorisation of clinical commissioning groups.
2012. Management. Personal Health Budgets (PHBs) roll-out. Norman Lamb announced the national roll-out of PHBs, following an independent evaluation which concluded they were often cost effective.
2012. Regulation. Revalidation for doctors. The General Medical Council required doctors to demonstrate that they were still fit to practise through a system of annual appraisal.
2013. Management. NHS Reorganisation (Major). The Health and Social Care Act 2012 created NHS England (NHSE) to oversee the budget, planning, delivery and day-to-day operation of commissioning and contracts for GPs and NHS dentists in England. The Act put more focus on public health and was also designed to strengthen commissioning. It also increased democratic accountability and public voice; with public health responsibilities transferred back to local government.
2013-6. Public Health. Public Health Outcomes Framework for England. The framework set out indicators to support the system to improve health protection and health improvement, and reduce health inequalities.
2013. Public Health. Public Health England (PHE). Created by the Health and Social Care Act 2012, PHE began operating as an executive agency of the DHSC responsible for improving and protecting public health.
The COVID-19 Pandemic of 2020 made it (painfully) unclear which agency was (and is) responsible for infectious disease prevention and control. Why? Local public health departments report to (and are part of) the council; and thus above that, the Department for Levelling Up, Housing and Communities (DLUHC). But nationally Public Health England (now called UKHSA), is allied to (but not a part of) NHS England and managed by the DHSC (see later).
2013. Management. NHS Services, Seven Days a Week Forum led by Sir Bruce Keogh, Medical Director of NHSE, produced 10 NHS Clinical Standards for a Seven Day Service. This led to a focus on four priority standards in 2015: Time to consultant review, Diagnostics, Consultant directed interventions and Daily consultant-directed review.
2013-4. Management/Integration. Better Care Fund (BCF). The government planned to transfer health services funding into a pooled budget for health and social care; there were early issues with implementation.
2013. Regulation/Scandal. Francis Report on Mid-Staffs scandal – made recommendations on care standards and issues, including the need for openness, public access to accurate information and cultural change.
2014. Public Health. Health Select Committee’s Report on Public Health England (after its first 7 months) raised concerns PHE staff did not feel able to contradict government policy.
2014. Management. ‘Five Year Forward View’, an NHS England plan, identified the need for a radical upgrade in preventative medicine and public health; supporting national action on obesity, alcohol and other major health risks.
2014. Management. Dementia Identification Scheme. NHS England offer GPs cash for dementia diagnoses, provoking strong media reaction and criticism from both doctors and the general public.
2014-6. Epidemic. Western African Ebola Virus Epidemic (2013-2016) caused 11,300 deaths globally, with a mortality of 40%.
2014. Mental Health. ‘Achieving Better Access to Mental Health Services by 2020’. The Department of Health set out national waiting time standards for mental health services.
2015. Management. ‘Devo Manc’. Greater Manchester became a pioneer project site for the devolution of NHS functions, intended to enable localities to integrate health and social services. 2015. Staff Numbers. NHS became the world’s fifth largest employer with 1.7 million staff.
2015 Conservative Government (David Cameron MP/Theresa May MP)
2015. Mental Health. Mental Health Targets. By April 2016, 75% of people referred to the IAPT programme in England were to begin treatment within 6 weeks; and greater than 50% of people experiencing a first episode of psychosis, were to start treatment within 2 weeks.
This was formalised in an NHSE document ‘Achieving Better Access to Mental Health Services by 2020’ (October 2014). Mental Health Target for Eating Disorders. 95% of children and young people referred should receive NICE-approved treatment within 1 week if the case is urgent, and 4 weeks non-urgent.
2015. Education/Union. Junior doctors’ strike. A junior doctors’ contract dispute in England, started in 2012, between NHS Employers and the British Medical Associate (BMA); partly as a response to the 7-day service standards of 2013.
2015. Management. Hinchingbrooke Hospital. Withdrawal of independent provider from Hinchingbrooke Hospital franchise contract. Circle – the first private company to manage an NHS trust – cited unprecedented Accident and Emergency attendances and funding cuts as reasons for the withdrawal.
2015. Management. New Care Models Programme and vanguard sites. NHS England invited individual organisations and partnerships to apply to become ‘vanguard’ sites for the New Care Models Programme (outlined in the the Five Year Forward View) – and the first 29 vanguard sites were announced.
2015. Open Culture. ‘Freedom to speak up’ review. Sir Robert Francis QC published an independent review on the creation of an open and honest reporting culture in the NHS. In January 2014 the ‘Duty of Candour’ definition, recommended by Francis, was published by the CQC. This set out the legal duty to be open and honest when things go wrong.
2016 Brexit. UK votes to leave the European Union
2016 Paris Agreement, signed by 195 nations to fight global warming, formally goes into effect
2016. Management. NHS Improvement (NHSI) was formed by the merger of Monitor and the TDA, with responsibility to oversee NHS hospitals and independent providers providing NHS-funded care.
2016. Public Health. Soft Drinks Industry Levy (SDIL). To help tackle childhood obesity, the government announced a manufacturer’s levy on added sugar drinks would apply from April 2018.
2016. Public Health. Tobacco Control. The UK Tobacco and Related Products Regulations implemented the European Union Tobacco Products Directive, bringing in larger picture health warnings and other changes.
2016. Public Health. Faecal immunochemical test (FIT) for bowel cancer detection. Following the National Screening Council’s recommendation, Public Health Minister Jane Ellison announced a change in technique for testing for bowel cancer.
2016. Management/Integration. Sustainability and Transformation Plans (STPs). NHS England announced plans for NHS providers (e.g. hospitals), Clinical Commissioning Groups (CCGs), Local Authorities, and other health and care services to come together to form 44 subregional STP ‘footprints’. These are geographic areas in which people and organisations will work together to develop robust plans to transform the way that health and care is planned and delivered for their populations. Most later became Integrated Care Systems (ICSs).
2017 Conservative Government (confidence and supply) (Theresa May MP/Boris Johnson MP)
2017 Grenfell Tower fire in London kills 72 and injures 70
2017 Terrorist bombing attack at an Ariana Grande concert in Manchester, kills 22 people and injures over 140
2017. Public Health. PrEP (Pre-exposure Prophylaxis) to Prevent HIV was made available to 10,000 people in England as part of the IMPACT trial. When taken according to instructions, it reduces the risk of HIV transmission to almost zero.
2017. Education. GMC introduced an alternative route to becoming a consultant or general practitioner in the UK: Certificate of Eligibility for Specialist Registration (CESR) or Certificate of Eligibility for GP Registration (CEGPR). This system is mainly for doctors, who have trained abroad, to recognise their skills and previous experience. More info on these here.
2018 Four people poisoned (one to died), in Salisbury and Amesbury,
in suspected Russian assassination attempt
2018. Management. Department of Health and Social Care. The government changed the name of the Department of Health to the Department of Health and Social Care. Doubts did and do exist whether social care is really under their control.
2018. Public Health. Fixed-odds Betting Terminals stake limit was reduced to £2.
2018. Public Health. Minimum Unit Pricing on alcohol was introduced in Scotland.
2018. Public Health. ‘Opt-out’ Organ Donation.
2018. Regulation. Bawa-Garba case. Dr Bawa-Garba successfully appealed a ruling that she be struck off the medical register after being found guilty of gross negligence manslaughter of a patient. The case caused great anger amongst doctors who felt she was being blamed for inadequacies of the hospital (including IT), and senior managers and doctors ‘above’ her.
2019 Conservative Government (Boris Johnson MP)
2019 Greta Thunberg delivers “How dare you” speech at UN Climate Action Summit
2019. Management. NHS 10 Year Long Term Plan (LTP). This is the current ten-year plan for the NHS in England. The plan aims to deliver improved health in early childhood, provide early diagnosis and prevention of major health problems, increase investment in mental health, and support people to age well. The plan also includes a focus on how to better employ data and digital technology in the NHS.
2019. Information Technology. NHSX was created in February 2019 and has oversight of digital strategy and policy in NHS England.
2019. Information Technology. NHS App was launched in January, enabling patients to access some of their GP record, organise appointments and renew prescriptions. This became significantly more popular in 2021, when it enabled the public to demonstrate their COVID-19 vaccinations.
2019. Management. NHS Reorganisation (Minor). NHS England’s Four Regions Split. Four NHSE regions were split into seven.
2019. Management. NHS Reorganisation (Minor). NHS England and NHS Improvement begin to merge.
The 2020s. COVID-19 and Health and Care Act 2022 (Integration)
Key events: Decade so far dominated by COVID-19 Pandemic. As a consequence of perceived poor performance, UK Health Security Agency (UK-HSA) formed out if Public Health England. Subregional Integrated Care Systems (ICSs) took over from local Clinical Commissioning Groups (CCGs). NHS Improvement incorporated into NHS England.
2020 Murder of George Floyd sparks protests across USA and world
2020. Public Health. The Abortion (Northern Ireland) Regulations 2020. Abortion was decriminalised in Northern Ireland.
2020. Pandemic. COVID-19. A new strain of coronavirus, SARS-Cov-2, was first identified in Wuhan, Hubei province, China, in late December 2019. It caused a Severe Acute Respiratory Syndrome, like SARS-Cov and MERS-Cov (other coronaviruses). On 11 March 2020, the World Health Organisation declared it a pandemic. Globally, over 15 million people have died (WHO estimate, May 2022).
The UK has been devastated with over 209,000 deaths in a population of 67 million, as of October 2022. This is significantly worse (pmp) than Australia, with approximately 15,600 deaths out of a 27 million population; raising serious questions about the fitness of the health system, particularly in its public health capability.
Despite these failings, the pandemic has led to a groundswell of public support for ‘our NHS’ including the national ‘Clap for our Carers’. ‘Protect the NHS’ as a key slogan. Homes, shops and parks across the country displayed rainbow symbols to show gratitude to the health service.
Professors Chris Whitty (Chief Medical Officer, CMO), Sir Patrick Valance (Chief Scientific Officer) and Jonathan Van Tam (Deputy CMO), advised by the SAGE (Scientific Advisory Group for Emergencies) panel of experts, became household names.
Three waves of the pandemic had happened by November 2021, the last one being significantly ameliorated by a successful vaccination programme. In the UK at that time, 80% had been ‘double vaccinated’.
2020. Public Health. Public Health England (PHE) to be dissolved. In August 2020, it was announced during the COVID-19 pandemic, that PHE was to merge with the NHS Test and Trace service and the Joint Biosecurity Centre to form a new agency, the National Institute for Health Protection (NIHP), under a single leadership team.
The new agency would start work immediately to lead England’s ongoing response to the pandemic. It was planned to start operating formally from Spring 2021, with a primary focus on public health protection and infectious disease capability.
2021 Supporters of President Donald Trump, gathered after a rally led by him,
attack the US capitol, leading to five deaths
2021. Public Health. UK Health Security Agency (UKHSA) formed. This replaced the NIHP and started work in April 2021. Its first Chief Executive was Dr Jenny Harries.
2021 Management/Education/Information Technology. In February 2021, the government confirmed its intention to merge NHS Improvement into NHS England in its Integration and Innovation white paper. In November 2011, it was announced that Health Education England (HEE), NHS Digital and NHSX were also to are to be incorporated into NHS England.
2022 Russian invasion of Ukraine
2022 Conservative Government (Liz Truss MP/Rishi Sunak MP)
2022 Deaths of Mikhail Gorbachev, and Queen Elizabeth II
2022. Management/Integration. NHS Reorganisation (Major). The Health and Care Act 2022 led to Integrated Care Systems (ICSs), developing out of STPs. ICSs are partnerships that bring together providers and commissioners of NHS and social care services, across a sub-regional geographical area (of about a million people). The are further attempt at increasing collaboration and integration over competition. As part of this act, the local level of NHS administration and finance was passed from CCGs to ICSs. 42 ICSs formed and started functioning in April 2022.
2022. Management. NHS Improvement merged into NHS England. The merger took place on 1 July 2022, at which point NHS Improvement ceased to exist, with its two legal entities, Monitor and the NHS Trust Development Authority, being abolished.
2023 Coronation of King Charles III
2023. Hospital flow. Year does not start well with jammed hospitals/A&Es in the news every day, combined with NHS workers’s strikes and recurrence of COVID-19 and flu.
2023. Management. NHS Digital and Health Education England (HEE) merged into NHS England.
2023. Education/Union. Junior doctors’ strike.
2023. Education/Union. Senior doctors (hospital consultants) strike.
2024. Government. Victoria Atkins MP replaces Stephen Barclay MP as Secretary of State for Health and Social Care.
2024 Labour government (Sir Keir Starmer, MP)
2024. Government. Wes Streeting MP replaces Victoria Atkins MP as Secretary of State for Health and Social Care.
Other resources
The Health Foundation have an extremely good timeline here.
The Nuffield Trust has a detailed history of the NHS here.
The BBC has historical charts here.
