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Watchdogs publish verdict on NHS reforms so far

13 June 2008

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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 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 besults 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 home. 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 underdeveloped 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: “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.”

Audit Commission