Acts, reports and white papers – 1996-2016

28 December 2016

Julie Griffiths takes a look at the 20 years to 2016 in the last of our ‘Looking back’ series.


Under John Major, three white papers are released: Choice and opportunity; The NHS: a service with ambitions; and Primary care: delivering the future. The latter is on partnerships in primary care, and between primary and secondary care and local authorities.


The NHS Primary Care Act enables possibilities for delivering primary care. GPs are encouraged to increase fl exibility and choice. Labour comes to power and publishes a white paper: The new NHS: modern, dependable, which says access to the NHS ‘will be based on need and need alone’.


The Acheson inquiry into health inequalities is published and NHS Direct is set up with the promise it will make a diff erence to the lives of people 24 hours a day, 365 days a year.


The National Institute for Health and Clinical Excellence (NICE) is established to standardise the quality of care across the NHS. An NHS reorganisation sees GP fundholding abolished and new primary care groups (PCGs) set up.


Prime minister Tony Blair commits to large and progressive increases in NHS funding. The NHS publishes a 10-year modernisation programm


The Health and Social Care Act 2001 formalises The NHS plan. As directed by the Health Act 1999, the Commission for Healthcare Improvement is created – the fi rstorganisation to formally assess the performance of NHS hospitals.


Another NHS reorganisation sees district health authorities replaced by strategic health authorities (SHAs) and primary care trusts (PCTs). The concept of foundation trusts is investigated. Sir Derek Wanless publishes his review into the long-term funding needs of the NHS, which suggests that future funding needs will depend on the extent to which future demand for health care is reduced by good public health policies and disease prevention. The report justifi es what is to be a 50% real-terms increase in NHS spending in the fi ve years after its publication.


In exchange for pay increases, NHS staff vote in favour of new framework Agenda for Change. The hope is the new system will help to increase the recruitment and retention of staff in the NHS. A new contract for GPs is negotiated, giving greater autonomy on the range of services they provide. The new contract increases wages and pensions.


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. It supports individual choice, personalised services and coordinated working between the public and private sectors. The fi rst 10 foundation trusts are established, with more control over their budgets and services. The government announces plans to devolve responsibility for commissioning services from PCTs to local GPs with practicebased commissioning.


The document commissioning a patient-led NHS outlines plans to better engage local clinicians in the design of services and roll-out practice-based commissioning faster.


The white paper, Our health, our care, our say, is published. It encourages patient choice and the movement of services out of hospitals into community services. The smoking ban is introduced in Scotland.


A smoking ban in England, Wales and Northern Ireland comes into eff ect.


Professor Sir (soon to become Lord) Darzi joins the government as a health minister and is tasked with leading a major review of the NHS to outline a 10-year vision for its future. His vision includes centralising specialist services and polyclinics are proposed. Health minister Lord Darzi leads the ‘NHS next stage review’ and outlines his 10-year vision for the NHS in the report, High quality care for all.


The NHS constitution is published, with revised rights and responsibilities for patients and staff . It proposes seven principles on how the NHS should act and make decisions, six core values and pledges to patients and staff , as well as a list of rights and responsibilities. These include treating patients with dignity and enabling informed choice. A new health and social care regulator in England, the Care Quality Commission (CQC), 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. NHS chief executive Sir David Nicholson warns the NHS to prepare for unprecedented effi ciency savings of £15bn to £20bn from 2011 to 2014.


A general election results in a coalition government between the Conservatives and Liberal Democrats. Among many pledges on health, the coalition agreement promises ‘no more top-down reorganisations of the NHS’. The white paper, Equity and excellence: liberating the NHS, is published and includes reforms such as scrapping performance targets, including waiting times, giving groups of GP practices ‘real’ budgets to buy care, abolishing all PCTs and SHAs, and creating a new NHS Commissioning Board. The government’s vision for public health in England is published in Healthy lives, healthy people. It proposes a new organisation – Public Health England – whose sole responsibility would be to provide advice on and infl uence 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.


The Health and Social Care Bill proposes reforms to increase the infl uence of GPs on commissioning,increase competition and abolish SHAs and PCTs. It envisages a bottom-up, clinically owned network of GP commissioning groups with budgets to buy care on behalf of their local communities. Public Health England is to the lead on public health at the national level, with local authorities taking the lead locally. The voice of patients is to be empowered through the establishment of a new national body, Healthwatch.


After nearly 18 months and thousands of amendments, the Health and Social Care Bill is passed. The NHS Commissioning Board (now NHS England) is established as an independent statutory body. It initially performs limited functions. A primary role is to establish and authorise clinical commissioning groups (CCGs) ahead of 1 April 2013. At the same time, Monitor starts to take on its new regulatory functions.


Robert Francis QC, chair of the Mid Staff ordshire NHS Foundation Trust public inquiry into poor care and high mortality rates, presents his fi nal report. PCTs are abolished as part of the Health and Social Care Act, their functions passing to NHS England and 211 CCGs. SHAs are also abolished. Health Education England takes on responsibility for education, training and workforce development. Public health responsibilities are transferred to local authorities. Public Health England is set up to improve the nation’s health and wellbeing and reduce inequalities. New health and wellbeing boards are established.


NHS England publishes its Five year forward view, outlining how the NHS needs to reduce health inequalities, improve quality of care and meet an estimated £30bn gap in funding by 2020-21.


The Conservatives come into power. One of their manifesto pledges is to spend an extra £8bn on the NHS over the next fi ve years. £600m of this is funded through cuts to public health. 2016: The EU referendum results in a vote to leave, despite health unions backing the remain campaign.