Progress with implementation of reform policy | Aims | Have the aims been met yet? |
FTs – 73 out of 171 acute and specialist trusts are FTs (a further 26 mental health trusts are FTs) | Stronger finances, greater efficiency | FTs started from a good financial position and have improved further. Income growth has been a significant contributor to the increasing surplus. Efficiency savings have also been made. FT application process has helped non-FTs improve financial management and financial stability. |
| Service improvement | FTs perform well, but they started from a better position than other trusts. Impact on any improvement is unclear. |
| Patient responsive services | Role of FT governors and membership is still developing. |
| Increased independence for providers | FT status allows autonomy and use of cash balances to deliver service improvements. |
PbR– Implementation by acute and specialist trusts, where the policy has been largely mainstreamed. Little implementation beyond the acute sector. By April 2008, all acute trusts reached 100% PbR price and purchasing parity adjustment phased out for all PCTs. | Fairness and transparency of funding | There is now a clear link between activity, income and expenditure, removing the need for much local price negotiation. |
| Efficiency | Day cases have increased and lengths of stay have fallen, particularly for elective inpatients. Where changes have occurred, PbR seems to have reinforced rather than driven change. |
| Faster access to more appropriate, patient responsive services | Increase in overall activity, but particularly short-stay activity such as day cases and non-elective short-stay admissions. However, other policies will have also contributed to these changes. PbR has encouraged PCTs to focus on demand management. |
| Increased focus on quality | Not a primary driver in changes in quality to date, although, while emergency readmissions are increasing, there is no evidence that PbR has resulted in a negative impact on quality overall. Rewarding quality is likely to be a focus in the future. |
PBC– Limited progress. | Better services closer to patients | PBC has only had a limited impact on service redesign to date. |
| Better use of resources to purchase services for patients | PBC has only had a limited impact on commissioning of services to date. |
| Reduced inequalities of outcome | There is potential to deliver this if PBC moves forward. |
Plurality and patient choice– Limited introduction of ISTCs. Variable availability of patient choice. | Greater choice of provider for patients | Greater choice is available for most patients. |
| Stimulating competition | The fear of new providers has stimulated some change. |
| Improvement in quality | Information does not yet exist to enable patients to make a decision based on quality of outcome or to determine whether quality has improved as a result of patient choice. |
| Increasing capacity | ISTC programme has increased capacity but progress has been slower than expected. |
| Tackling health inequalities | No evidence that choice or ISTCs have reduced health inequalities. |
Workforce contracts– Fully implemented. | Flexible workforce | Mixed progress has been made. The contracts have introduced some flexibility, but implementation has alienated some staff. |
| Delivering different services in new and better ways | Contracts have supported but not driven service redesign. |
| Increased productivity | The new hospital contracts resulted in an increase in costs without an associated increase in productivity. |
| Improvements in quality of care | Measures of quality did not improve significantly after introduction of new contracts, although it would be difficult to attribute any change to this. |
| Resolving recruitment and retention issues | Problems were largely solved in advance of new contract implementation. |