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NHS system reforms have improved management of the health service but need more time to deliver significant benefits for patients.

This is the main finding of a report Is the treatment working? Progress with the NHS system reform programme published jointly yesterday (12 June) by the Audit Commission and the Healthcare Commission.

The study looks at the ambitious programme of market-style reforms that aim to improve efficiency and effectiveness and were first set out in the NHS Plan of 2000. It evaluates the key elements: giving patients more choice; greater NHS use of the independent sector; the creation of foundation trusts; practice based commissioning; and Payment by Results. It also reviewed the impact of major changes to employment contracts with NHS staff.

The research found that some of the reforms are beginning to work, particularly those focused on encouraging better financial management and a more business-like approach among NHS organisations providing care, through Payment by Results and setting up foundation trusts. There is also evidence that competition, or the possibility of it, to provide NHS care from a range of independent organisations has led to improved services in some areas. There is evidence, too, that general standards are improving across the NHS.

But the report found that some of the changes, particularly those most noticeable to patients such as choice, need more time to deliver significant results. It reveals that there has been limited progress moving care out of hospitals and closer to ome. Evidence was found that patient choice can work but, to drive improvement, the choices offered to patients for treatment need to be realistic and supported by more timely and accurate information than is currently provided.

The report recommends that further nationally imposed structural changes should be avoided as progress to date has been hampered by two major reorganisations since the reforms were introduced. Other factors include an under-developed capacity to commission patient services and weaknesses in the systems to support and monitor improvements.

Michael O’Higgins, Chairman of the Audit Commission, said:

‘We don't under-estimate the scale of the challenge of reforming the NHS. It employs four times more people than Tesco and is a much more complex organisation, so it will take time to deliver such major changes. But given the massive investment in the NHS in recent years, taxpayers and patients rightly expect that their money is spent as efficiently as possible and that services are improving. The NHS must keep the pressure on to make these reforms work for patients.’

Sir Ian Kennedy, the Healthcare Commission’s Chairman, said:

‘This is an important and timely stock-take on progress. These were ambitious reforms that were never going to be easy to deliver. It's clear that there have been advances in important areas and that the building blocks are in place for more significant improvements in the quality of care.

‘It's also clear that the reforms have not yet achieved what was promised and that progress is behind what some might have hoped for at this point. These policies are only a means to an end. They have got to make the care of patients better. Yes, they have triggered improvements for patients, but there’s still some way to go.’

Is the treatment working? - Progress with the NHS system reform programme (pdf 670kb) (opens new window)

Is the treatment working? - Progress with the NHS system reform programme (Summary) (pdf 340kb) (opens new window)

Notes to editors

1. Payment by Results is a system of paying hospitals nationally set prices for the number of patients and types of conditions they treat. It is designed to encourage hospitals to treat more patients, more efficiently.

2. Practice based commissioning aims to give GP practices and primary care professionals the resources and freedom to develop new local services and more choice for patients.

3. The NHS Plan 2000 outlined the vision of a health service designed around the patient: a new delivery system for the NHS as well as changes between health and social services, changes for NHS doctors, for nurses, midwives, therapists and other NHS staff, for patients and in the relationship between the NHS and the private sector. See Figure 1 in the report.

4. The authors held workshops in Manchester, Peterborough, South Yorkshire and Worcestershire with participants from 6 SHAs; 9 PCTs; 6 acute trusts; and 5 FTs Interviews were also held with hospital clinicians; GPs; non-executive directors; and FT governors. The views of patients were gained through analysis of the results of the DH Choice survey. The authors also held a series of interviews with commissioners, providers and strategists based in London. Follow-up interviews to further expand on the issues raised at the workshops were held with attendees and other national organisations, including other health regulators; health commentators; and independent sector providers.

5. External literature, parallel studies and national and local data were also considered. These include: Early Lessons from Payment by Results (Audit Commission, 2005) and The right result? Payment by Results 2003-07 (Audit Commission, 2008); Putting commissioning into practice (Audit Commission, 2007); A prescription for partnership: engaging clinicians in financial management (Audit Commission, 2007); Independent Sector Treatment Centres: A review of the quality of care (Healthcare Commission, 2007)

6. The Audit Commission is an independent watchdog, driving economy, efficiency and effectiveness in local public services to deliver better outcomes for everyone.

Our work across local government, health, housing, community safety and fire and rescue services means that we have a unique perspective. We promote value for money for taxpayers, covering £180 billion spent by 11,000 local public bodies.

As a force for improvement, we work in partnership to assess local public services and make practical recommendations for promoting a better quality of life for people.

7. Further details about the role of the Audit Commission can be obtained from
www.audit-commission.gov.uk.

8. The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Healthcare Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

For further information please contact:
Rebecca Murrell, Audit Commission
Tel: 0844 798 2262/2128
Mob: 07876 217686
Email: r-murrell@audit-commission.gov.uk

Sarah Robertson, Healthcare Commission
Tel: 020 7448 9313
Email: Sarah.Robertson@healthcarecommission.org.uk