Seasonal flu

A year ago, Britain was gripped not only by snow but also la grippe. Seasonal flu, including the swine flu strain, was putting intense pressure on hospitals and intensive care beds in particular. GPs faced vaccine shortages, which had to be shored up by resorting to leftover stock from the 2009 swine flu pandemic. It is clear the Government is now taking no chances with this winter, and has ordered in extra stock to be held centrally. Figures from the Health Protection Agency, released in May, showed there were 602 confirmed flu deaths over the 2010/11 winter season. Of those, 562 were linked to swine flu.

While flu preoccupied Britain in the first few weeks of the year, international researchers were hailing a find that should prove to be much more significant, in global terms. The RTS, S/AS01E vaccine was found to cut the number of severe malaria cases in children aged five to 17 months by 46 per cent.

With the virus killing about 800,000 annually, mostly in sub-Saharan Africa, if the vaccine is rolled out it could end up saving millions of lives. As the year progressed, it became clear that the NHS was coming under more and more strain due to tightening budgets.

With finance managers under pressure to improve productivity by four per cent a year, and with many trusts struggling to pay the onerous terms of PFI contracts, hospital managers started to raise the thresholds for operations like cataract removals, varicose veins and even hip and knee operations.

Primary care trusts also started to restrict access to some drugs, even those approved by the National Institute for Health and Clinical Excellence (Nice).

It is against this backdrop that by far the biggest health policy story of the year has been played out: the stormy ride of the Health and Social Care Bill through parliament. With mounting opposition from much of the medical profession to the Bill, Nick Clegg, the Deputy Prime Minister, broke ranks to describe it as a "disruptive revolution".

Significant amendments were subsequently made, which should make it harder for private firms to "cherry pick" profitable NHS services, and reducing the emphasis on competition. Opponents of the Bill welcomed the changes, while supporters feared they emasculated it.

It continued to attract opposition in the Lords, although an attempt led by Lord Owen to have parts dealing with the Health Secretary's responsibilities for the NHS scrutinised by a special committee was defeated in October. It is now highly likely the Bill will become law.

Exactly how it will be enacted, and what difference it makes to how the NHS works and the way patients are treated, will only begin to be sketched out in the coming year.

Andrew Lansley, the Health Secretary, has maintained throughout that the changes, which will see primary care trusts and strategic health authorities abolished, and GPs put in charge of over half the NHS budget, are necessary to save the NHS from being engulfed in a long-term "financial crisis".

Part of Mr Lansley's rationale for reforming the NHS is Britain's ageing population. The growing number of older people is also behind another problem the Government faced in 2011 - and will continue to face in the future - social care for the elderly.

Bupa warned that the lack of care home places would lead to an "intolerable" bed blocking crisis by the end of the decade, with wards filled with elderly people who should be cared for elsewhere. NHS figures showed rates rose 16 per cent in a year and that "delayed discharges" were costing the service almost £500,000 a day.

The Dilnot Review, chaired by economist Andrew Dilnot, suggested individuals' contributions should be capped at £35,000, but his radical plans have yet to be adopted by the Government.

The Cancer Drugs Fund, one of David Cameron's eye-catching election promises, has proved positive after a slow start. The Government set aside £200 million a year for drugs not recommended by the National Institute for Clinical Excellence (Nice) for use on the NHS. Left to regional health authorities to organise, there have unsurprisingly been wide geographical variations in its use. Nonetheless, cancer charities have broadly welcomed the initiative, which the Government claims has helped almost 7,000 people by the end of September.

The NHS Breast Cancer Screening Programme has come under scrutiny after researchers called into question the balance of benefits - finding tumours early - and risks - overdiagnosing pre-cancerous lesions that might not prove malignant, leading to unnecessary surgery.