13 June 2008
The government has pumped £1bn into introducing market-style reforms in the NHS, but they have not yet brought significant benefits to patients, two watchdogs have found.
In a joint report on the market-orientated mechanisms – payment by results; practice-based commissioning; the Patient Choice programme; use of the private sector; and the introduction of foundation trusts – the Healthcare Commission and the Audit Commission say the NHS has made 'significant progress' since the new systems were announced in the 2000 NHS Plan.
'However, it is difficult to attribute any of these changes to the system reform programme,' it says.
Increased investment in the NHS, waiting-time targets and National Service Frameworks were perceived by NHS staff 'to have had much more of an impact', it notes.
The June 12 report, Is the treatment working?, says the reforms have the 'potential to deliver significant service improvements'. But the watchdogs found they had not yet had a national impact on the quality of care, despite some local successes.
Healthcare Commission chair Sir Ian Kennedy said: 'These reforms have triggered improvement both in organisation and management, but there's still some way to go before patients get any significant benefits.
'It's hard to point, except in specific examples, to improvements or change [in quality of patient care].'
Audit Commission chair Michael O'Higgins said: 'If there are not significant impacts by, say, two years, I think there would be serious questions.'
There was not necessarily any correlation between implementation of the system reforms and improvements in patient care. 'We have identified that service improvement in some areas has been substantially delivered without using the system reforms,' the report says.
The reforms had also failed to achieve major policy objectives, such as shifting services out of hospitals and into the community.
Audit Commission officials put the cost of the market reforms at around £1bn since 2004/05. But the report notes that costing for some elements is vague, with estimates for Patient Choice ranging 'between £4.9m and £43.1m'.
PFjun2008
