Will 2010 be viewed as a pivotal year for health?

The change in government has seen a change in direction in the health service

Bar a few weeks in the summer when ministers hit the headlines for some plain talking about obesity and TV chef Jamie Oliver, 2010 for health and social care will probably be best remembered for one thing - money.

It was the year when the whole sector in England became obsessed with how much there would be, where it was coming from and who was going to spend it.

The year kicked-off with - unusually - social care hogging the headlines.

By the end of 2009, all three parties were beginning to make noises about sorting out the issue of social care funding once and for all.

Tony Blair had promised something similar when he came to power in 1997. But found his focus increasingly shifted towards the NHS, from the less glamorous issue of caring for the elderly and disabled.

But in the early part of 2010 hostilities broke out after the Tories accused Labour of wanting to introduce a death tax in England. This was based on their proposal to impose a compulsory levy on people to pay for social care.

The system is currently means-tested, but with councils increasingly rationing access to services many have argued change is inevitable.

A white paper in March, just before the general election, effectively punted the issue into the long-grass by promising not to introduce anything for the length of the next parliament.

And, as a result, the agenda soon shifted back on to the NHS.

The Tories, with the Lib Dems at their side, came to power promising above inflation increases in NHS funding and no major reorganisation.

But the coalition's first major foray on the NHS - under the stewardship of Andrew Lansley who had spent more than six years shadowing the brief - was to announce a radical shake-up of the system that was to dominate much of the debate for the remainder of the year.

Obesity

In July, Mr Lansley set out plans to give GPs control of about 80% of the NHS budget, claiming they were in a better to position to know what worked best for patients than managers.

As part of the shake-up two tiers of management - 10 strategic health authorities and 151 primary care trusts - were told they would be scrapped.

The news divided opinion - and caused much furore because it had not been highlighted during the election campaign. Although Tory policy documents had set out some of the changes.

The summer also saw Mr Lansley go head-to-head with one of the nation's favourite chefs.

As he held a question-and-answer session at the British Medical Association's annual conference, Mr Lansley was asked about his plans to tackle public health.

He immediately attacked Labour's record, accusing the previous government of being too dictatorial. Giving an example, he cited the movement that built up around Jamie Oliver's school dinners campaign, saying it smacked of lecturing to people.

Unfortunately, for the health secretary his comments were interpreted as an attack on the popular celebrity chef and he found himself in the line on fire.

Hot on his heels, one of his junior ministers, Anne Milton, sparked a frenzied debate by saying people should use the term fat rather than obese as it was more likely to get people to take action.

While both politicians were left defending themselves, the remarks did suggest the government wanted to change the emphasis on the debate about how people live their lives.

The buzz word was personal responsibility and this became the central thrust of a public health white paper that was published at the November.

Money

But by that time the debate was very much back on the issue of money.

One of the major criticisms was that a reorganisation on the scale being proposed by Mr Lansley - some called it the most far-reaching since the NHS began - would be difficult during a period when the NHS was having to cut costs.

While the health service in England did receive an above inflation rise, it was still one of its toughest settlements ever.

The government was only able to promise budget rises of 0.1% above inflation.

But as costs are rising in the NHS faster than elsewehre in the economy - largely due to the price of new drugs, the ageing population and lifestyle factors such as obesity - many argued it felt more like a cut than a rise and predicted the NHS could start to struggle.

In fact, the first signs of that may have already started to emerge.

The final weeks of the year have been dominated by concern about the amount of strain the NHS was coming under because of winter pressures, such as flu, norovirus and the impact of the snow.

The government has maintained the health service can cope, but with everyone now watching for any signs of cracks appearing how the NHS reacts to the new landscape promises to be the touchstone issue for 2011.