A Chronology of State Medicine, Public Health, Welfare and Related ...

The Department of Health published "Our Healthier Nation. A Contract for Health",
Cm. 3852; the Scottish Home ad Health Department published "Working Together for a
Healthier Scotland", Cm.3854 (and see 1999); and the Welsh Office "Better Health. Better
Wales", Cm. 3922. The English document set health targets for the next ten years; and
acknowledging the
1998 Cont 2
1998 cont influence of adverse social, economic and environmental factors as causes of illhealth,
promised action across government departments to tackle poor housing, low wages,
unemployment, crime and air pollution.
"The National Health Service Wales: Putting Patients First", White Paper, Cm. 3841,
proposed the formation of local health groups based on 22 unitary council areas; and
measures to increase co-operation between the health and related services.
The Department of Health published "Information for Health. An Information Strategy
for the Modern NHS. 1998 - 2005". The proposals include lifelong electronic health records;
on-line access to patients records and to "best clinical practice" for all NHS clinicians; a
National Electronic Library for Health; shared information for general practitioners, hospitals
and community services through the NHS information highway; on-line information services
for the public; and improved information for planners and managers.
"Modernising Health and Social Services: National Priorities Guidance 1999/00 -
2001/02" set out the Government's key objectives as the reduction of the incidence of
avoidable illness, disease and injury; the treatment of patients quickly, effectively, and on the
basis of need alone; to enable chronically ill or disabled people to live as full and normal
lives as possible; and to maximise the social development of children within stable family
settings. To achieve these objectives the Government proposed to tackle the root causes of ill
health; break down barriers between services; and ensure uniformly high standards of care.
The Department of Health published a Green Paper, "A First Class Service: Quality in
the New NHS", setting out proposals for two new statutory bodies for England - a National
Institute for Clinical Excellence to provide national standards of treatment, and a
Commission for Health Improvement to ensure that the highest standards are met (see 1997).
See 1999.
"Acute Services Review Report", on the hospital services in Scotland, recommended
the establishment of managed clinical networks involving staff from a number of hospitals
working collaboratively to design and deliver care; improvement of services to remote
communities; the creation of an integrated child care service; the development of new career
pathways for doctors; and the extension of the roles of nurses and other professionals allied to
medicine.
A report from the British Medical Association, and of the Royal Colleges of Physicians
and of Surgeons recommended that the ideal size of a unit to provide fully comprehensive
medical and surgical care is a hospital or integrated group of hospitals serving a population of
about 500,000. The report said that it will not be possible for each locality to have its own
acute hospital and accident and emergency unit. Where district general hospitals cannot
amalgamate for geographical reasons, they should cooperate with adjacent acute hospitals.
Local hospitals which can no longer provide acute services should continue to provide
outpatient services and rehabilitation care. See 1999.
In "Modernising Mental Health Services" the Government set out detailed plans for
reforming the general psychiatric services accepting that "community care has failed" due to
underfunding, inadequate services, overburdening of families, problems in recruiting and
retaining staff and outdated legal framework. The new strategy should be based on increased