A Voice for the UK Care Pathway Community of Practice

Critical path and process-mapping methodology was used in industry, particularly in the field of engineering from as early as the 1950s. In the 1980s, clinicians in the USA began to develop the pathway tool within managed care; they were re-defining the delivery of care and attempting to identify measurable outcomes. They were focusing on the patient rather than the system, but needed to demonstrate efficient processes in order to fulfill the requirements of the insurance industry. In the early 1990s the National Health Service (NHS) in the UK funded a patient-focused initiative to support organizational change. This resulted in the investigation and development of concepts such as pathways. In 1990, a team from the UK visited the USA to investigate the use of these pathways, or ‘Anticipated Recovery Pathways’ as they were then called. As a result of this visit, 12 pilot sites for pathways were set up in Northwest London in 1991–92. The West Midlands Pathway Development work also got underway. By 1994, the Anticipated Recovery Pathway had evolved into the Integrated Care Pathway (ICP) in the UK. ICPs were clinician led and driven, and had patients and locally agreed, best practice at their heart. In response to demand for a coordinated UK ICP users group, the National Pathways User Group (later re-named the National Pathways Association [NPA]) was set up in 1994. A popular and well-supported group, it finally folded in 2002, a casualty of the time required by volunteers to lead the group and administer its running. In 2002, at about the same time that the NPA folded, the National Electronic Library for Health (NeLH) Pathways Database was launched to enable the free sharing of ICPs and ICP projects across the UK. Since 1991, ICPs have been developed and implemented across all health care settings in the UK (acute, community, primary, mental health, private, independent, NHS). ICPs are now used all around the world including Africa, Australia, Belgium, Canada, Denmark, Germany, Hong Kong, Italy, the Netherlands, New Zealand, the UK, and the USA. However, the UK has formalized the systematic development, implementation and use of care pathways by embedding them in national policy, identifying them as the vehicle for implementation, demonstration/monitoring and evaluation of all health and social care policies, strategies, initiatives and agendas at the frontline.