About this site
The Policy Navigator website is a tool for policy makers, researchers and enthusiasts to understand how our current health and social care policy landscape has developed, and to learn from the past.
The Navigator charts some of the major policies and related developments in health and care from the emergence of the first hospitals in England in the 11th century right up to modern day. The focus is on domestic policy rather than international developments, and primarily covers England rather than the devolved administrations.
There is no perfect way of organising the content. We have grouped developments by three themes: NHS reform, adult social care and public health. Of course, there is significant overlap between these – some entries appear within multiple themes. We also link to our COVID-19 policy tracker.
We have also ordered the content chronologically and you can filter entries by time periods. The first time period covers historical context (pre-1948) and the second covers the first three decades following the creation of the NHS in 1948. From May 1979 onwards – when Margaret Thatcher came to power – time periods cover the tenures of different prime ministers.
Where possible we have linked to open-access, electronic sources but in a minority of cases this has not been possible, particularly for some of the older entries.
While there is a wealth of material, this resource inevitably contains omissions. Following a refresh of the original site, content from 2015 onwards focuses on major developments, giving a high level overview. We will be aiming to update the website regularly, but maintaining a lag between events and the update, to give the benefit of hindsight about the relevancy of different developments. We would be very grateful for any feedback – contact details are at the bottom of this page.
About the themes
NHS reform
The creation of the National Health Service on 5 July 1948 introduced the provision of services free at the point of use for all (with some exceptions such as prescriptions). However, the origins of the NHS go back much further. Starting in 1066, this theme explores the development of the hospital infrastructure from which the NHS emerged.
This theme follows various government reform mechanisms. It covers the development of professional regulation since the 15th century – when petitions to King Henry V asked that only those with appropriate qualifications be allowed to practise medicine – and the unstable history of organisational regulation as different regulatory bodies have been set up to assess NHS providers.
The theme demonstrates the policy focus on competition for the provision of clinical care in the NHS from 1989, when the introduction of the ‘internal market’ led to the separation of purchasing from provision. It shows the variability in purchasing (or commissioning) organisations (all with slightly different functions) since then, from Clinical Commissioning Groups to GP-fundholders. And, it tracks the shift since around 2015 towards integrating services – both within the NHS and across health and social care.
The story of the NHS is a story of constant reform (or more simply, change) both as a response to technological and medical advances, the financial climate and as a result of central and local-level reorganisations.
Adult social care
Today, adult social care refers to a broad range of services and providers including residential care homes, nursing homes and supported living. Adult social care in England includes all forms of personal care and practical assistance provided for people in need aged 18 and over. This theme charts the emergence of formal social care services and the split between health and social care.
The concept of social care was relatively late in developing. Its origins lie in the 1601 Poor Law Act and the Poor Law Amendment Act of 1834. As the 19th century progressed, health care was gradually separated from the provisions under the Poor Law, but it wasn't until 1948 that other forms of public assistance were completely detached from the Poor Laws.
The decision to nationalise hospitals as part of the NHS rather than giving the administration of hospitals to local government marked the start of a perennial debate over the boundaries between NHS organisations and local authorities, and the separation between health and social care services.
Unlike the NHS, adult social care policy has often been characterised by stasis rather than flux – particularly in recent years. Government after government has failed in their promises to deliver a sustainable funding system, from Labour's 1997 manifesto commitment to 'a fair system for funding long-term care for the elderly' to the Conservatives' 2017 announcement of green paper that has never emerged.
Public health
The public health theme covers the response to disease outbreaks, the introduction of public health services and campaigns, and England’s experience of environmental threats to health over time. While in more modern times, the policy focus on health services has often been at the expense of population health, throughout the 19th century it was arguably public health developments (and not developments in the provision of health services) that had some of the greatest impact on health outcomes. We look at developments in sanitation and the environment, the bacteriological revolution, 'social hygiene' and 'new public health'.
The theme focuses on policy, campaigns, publications or the creation of organisations with an explicit aim to improve population health. As a result, there is limited inclusion of social determinant-related policies which are not primarily targeted at improving population health, despite their potential impact. We hope though that it will give a flavour of some of the major developments in public health and record some of the more modern policy changes that have been taken at a national level.
COVID-19 policy tracker
During the coronavirus pandemic, we have been tracking the national policy and health system responses to COVID-19 in England with our COVID-19 policy tracker. It details what changes have been introduced, when, why, and by whom – as well as how these changes have been communicated by policymakers. We track policy changes in five areas (from health and care system changes to wider social and economic policy) and update it on a weekly basis with the latest information.
Acknowledgements
Numerous Health Foundation staff past and present have been involved in this project. We would like to thank all staff involved for their support. We would also like to thank Geoffrey Rivett, David Walden, Alex Mold and Virginia Berridge for their valued feedback and suggestions on the original content.
Any errors or omissions are those of the Health Foundation.
Help us improve this website
Inevitably, there will be items that we miss or choose not to include. There may also be other data worth collecting, or new ways to present it to make it easier to use.
Please email Lucinda Allen from the Health Foundation's Policy team if you think anything is missing, incorrect, out of date, or could be improved.