The King’s Fund celebrated its centenary in 1997 against a backdrop of change. After 18 years as the Fund’s chief executive, Robert Maxwell resigned and Rabbi Julia Neuberger succeeded him. In December 1997, the structure of the Fund, created as a result of its post-war re-organisation, changed (p 5). The staff training colleges that had been in place since the early 1950s were replaced by a new corporate structure that could respond to the changing world of charitable governance and new demands in health care.
Traditionally, the Fund had been involved in developing London’s hospitals, but this period saw it expand its influence in areas such as care for older people and the capital’s mental health services. The London Commission was established to address these growing challenges, and its findings were published in the 1997 Transforming health in London report. ‘Transformation’ was everywhere at the time – only a few months previously, Tony Blair’s New Labour government had been elected in a dramatic turn of events, ending 18 years of Conservative leadership.
The Fund started to expand its focus, looking at opportunities to build collaboration and more co-ordinated systems within health care. The Transforming health in London report called for the construction of ‘local health economies’ – collaborative groupings involving ‘statutory authorities, clinicians, service users and other interested parties with a remit to develop integrated systems of care for large population groups across the capital’ (p 128). This focus on local population health needs and integrated budgets foreshadowed more recent initiatives, such as sustainability and transformation partnerships and accountable care organisations.
There were other unwitting prophecies of things to come. 1997 was also the year of the Scottish and Welsh devolution referenda and David Hunter, Professor of Health Policy and Management, The Nuffield Institute for Health, commented (p 37) at the time, in an eerie prediction of Devo-Manc and London:
With devolution to Scotland and Wales now a certainty, future policy-making in areas like health will not remain so centralised. It is likely, too, that England will not escape pressure from at least some of its regions to devolve power to regional assemblies at some future date.
The King’s Fund observed the government’s increasing interest in devolution. In its 2002 Five-year health check report, the Fund noted that it was not surprising that the government wanted to devolve responsibility for health care, otherwise it could be ‘held responsible for everything that goes wrong’ (p 5). However, the question of how to support local empowerment while also ensuring equity across different geographical areas remained unresolved. The King’s Fund commented on the extreme variation in health status that existed between areas, for example, between electoral wards in Scotland (p 221). But the possible benefit of devolution to ‘return’ health services to local democratic control was recognised, and improvements in working relationships between health services and local government was expected (p 225).
At the turn of the millennium, the Fund continued to focus on the ‘health needs of London and Londoners’ (p 3). It worked with the newly established Greater London Authority (GLA) and made a ‘Millennium declaration’ which set out the key priorities of the London Mayor and the GLA: tackling health inequalities; regenerating London’s deprived areas; creating a healthy transport strategy; improving community safety; and involving Londoners and establishing partnerships (p 52). These continue to be priorities today, as documented in the 2014 Better health for London report. Although the Fund now works across England to improve health and care, its local expertise continues to help people make sense of London’s complex health environment, as demonstrated in its recent assessment with the Nuffield Trust of London’s sustainability and transformation plans.
In the early 2000s, the Fund was still growing and adapting to the health challenges of the new century. The Health Quality Service (HQS), which was originally established as The King’s Fund Organisational Audit in 1989, seceded from the Fund to become an independent charity, providing quality assurance programmes for health services in the UK. It was around this time that the Enhancing the Healing Environment (EHE) programme was launched, as part of The King’s Fund’s activities to mark the millennium. This grant scheme originally focused on improving the acute hospital environment in London, but was then extended to mental health trusts and a number of primary care trusts outside the capital, with the assistance of the Department of Health and other charitable organisations (p 4). Later phases of the project included work to improve environments for care at the end of life and the environment of care for people with dementia. By the time the programme was completed in 2012, The King’s Fund had worked with 48 NHS trusts and more than 250 teams from acute, mental health and community hospitals, hospices and HM prisons.
The Fund’s 120-year anniversary has been a great opportunity to reflect on its history and impact. It’s been fascinating to learn how the work of the Fund has changed but also to note how some themes – for example integrated care, health inequalities and NHS reorganisation – crop up again and again over the decades. With the NHS facing unprecedented challenges as it enters its 70th year, the Fund will continue to support health leaders and provide insight and analysis to support our vision of better health and care for all in England. We hope, and expect, to be doing this for many years to come.