A brief history of health and care: 125 years of influence and insight at The King’s Fund

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2022 marks the 125th anniversary of the founding of The King’s Fund. Looking back over those years, are there any common themes from the past and any lessons for the future? 

The King’s Fund was created to help pay for health care, so naturally concerns over funding feature strongly in its history. The focus of these concerns has undergone a fundamental change over the years. The original focus – to raise money to pay for health care – remained the Fund’s central purpose until the NHS was established. Its focus then pivoted to debating the level of public spending on health, as our 1971 report, Do we spend enough on healthcare?, illustrates. From providing an independent source of revenue to voluntary hospitals, the Fund has evolved to use this same independence to provide insight, analysis and support. 

As part of supporting people and leaders to learn and develop, the Fund has also provided a safe space to discuss and to learn.

Workforce and leadership have always been a core part of the Fund’s business. The Fund established its own Nurse Recruitment Centre in 1940 to help alleviate staff shortages and its first Staff College in 1949 to begin training leaders and managers. This aspect of the Fund’s work has grown over time and has, since the 1990s, included specific support for women in leadership. Coincidentally, this year also represents the 40th anniversary of another key programme – the Top Manager Programme. As part of supporting people and leaders to learn and develop, the Fund has also provided a safe space to discuss and to learn, whether through formal conferences or informal gatherings. This was greatly facilitated after it moved to Cavendish Square in 1997 and now has expanded into the digital sphere as well.  

Population health may be a 21st century phrase, but the Fund first stepped in to support better integration of services in 1968 with its Working together report. This, in turn, had built on earlier work by the Fund on care for older people after discharge, or the `aged sick’ as they were called in 1951 (the social care system as we would call it today) and, from 1948, support for social care workers. The Fund continued to look beyond the boundaries of the traditional health care system, including working on the rights of people with disabilities. Formal work on public health came slightly later, but by the 1990s the Fund was advising the NHS on developing its public health function. Across all these areas, and others, the interest of the Fund in supporting best practice goes back to its founding in the 19th century, or 'carrying out greater efficiency and increasing their usefulness’ as the Victorian version was expressed.

Improving the patient’s journey and experience may also seem a more recent priority for health and care, but again, there is a long history of concern. This included researching the best time to wake patients up (1931’s Patients’ waking hour in London voluntary hospitals), to the 1950s’ recommendations of libraries in hospitals to give patients something to read. In more recent times it also led into work around Enhancing the Healing Environment that looked to improve care settings for patients in institutional care and now a new focus on the lived experience of patients and users. 

Of course, for an organisation well past its 100th birthday, our history does contain its stranger moments (at least to a modern audience). I wonder if the Charity Commission would raise an eyebrow at our Propaganda Committee? Whether medtech companies appreciated the competition from the Fund when we designed a (very successful and still widely used) hospital bed? Or quite what the Health and Safety Executive would say to our special lead-lined car that shuttled radioactive materials around London for the benefit of its hospitals? And if our long-running interest in the quality of hospital food is itself easy to understand, our records of hospital menus from the past is an eye-opener: if unlucky enough to have been a patient in 1945, I am sure I would have appreciated the rum baba, raised an eyebrow over tripe and been confused about the Cabinet Pudding.   

But the longest-running theme through our history goes back right to the Fund’s origins in 1897. Fifty years before the advent of the NHS, many patients relied on voluntary hospitals to provide their care. The Fund’s original purpose of funding voluntary hospitals was rooted in a desire to ensure people from all parts of the community had access to health care. The concern over inequalities has continued to run through much of its work since then and, from the end of the 1970s, this included considering how services could better meet the health needs of people from London’s minority ethnic communities. The commitment to tackling health inequalities is also at the centre of our partnership with GSK to support the work of the voluntary and community sector through the GSK IMPACT Awards, which coincidentally also celebrates its 25th anniversary this year. As we emerge from the Covid-19 pandemic, England’s recent track record in inequalities is not a good one and reducing inequalities will need renewed focus. 

The Fund continues to act as an independent voice providing insight and analysis, supporting people and leaders, bringing people together and sharing best practice.

Standing back, what does all this suggest? That the fundamentals of secure and sustainable funding must go hand in hand with support for, and with sufficient numbers of, staff. That these fundamentals then need to be brought together in their different organisations and systems to work to improve both the health of the population and user experience. And that sustained and concerted action is needed to use these resources and skills to lean against the inequalities in health that continue to have as much salience in 2022 as they did in 1897. Within this context, the Fund continues to act as an independent voice providing insight and analysis, supporting people and leaders, bringing people together and sharing best practice. The Fund’s 125-year anniversary provides an opportunity to reflect both on our history and what we do in the future. 

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