Page last updated at 23:01 GMT, Wednesday, 11 June 2008 00:01 UK

Progress on NHS's reforms 'slow'

Hospital ward
Ministers have introduced market-style reforms

Patients in England are yet to see some of the benefits of the NHS market-based reform programme because progress is slower than expected, watchdogs say.

The Audit Commission and Healthcare Commission report said this was partly due to unrealistic expectations.

They highlighted problems with patient choice and moving care away from hospitals, but said overall the NHS was heading in the right direction.

The government said it would press on with the programme.

The report said ministers had set out an "ambitious" programme of market-style reforms in the 2000 NHS plan to make the health service more efficient and effective.

Patient choice - Since the start of 2006 patients have been given choice over where they have non-emergency hospital treatment
Money follows patient - Hospitals used to be paid a lump sum regardless of how many patients they saw in a given year, but now for most forms of treatment they are paid per patient treated under payment by results
Variety of providers - Private sector invited into NHS to compete with hospitals for patients. Firms now carry out about a 10th of all NHS operations

This has involved paying hospitals per patient treated, rather than in lump sums, under a system called payment by results and giving patients choice over where they are treated.

Hospitals have also been allowed to apply to free themselves from central control by becoming foundation trusts, which allows them to operate much more like business, while the private sector has been invited to compete for patients.

The thinking behind the changes was that it would make the NHS more competitive and cut out waste, although they have proved controversial with many of the health unions.

The model has also been rejected by the devolved governments in Northern Ireland, Wales and Scotland.

The watchdogs were tasked with looking at progress with the programme, rather than the rights and wrongs of the policies.

They said to some extent the reforms were proving successful as the NHS was seeing more patients more quickly, standards had improved and financial management was more transparent.

But they added the scale of task had been underestimated and had suffered from a lack of a clear vision.

The report said many of the improvements were being driven by fear of patients exercising their right to choose rather than because they were actually using it.


It suggested this was because patients were not being given enough information to compare hospital performance, and delays had dogged the roll-out of the online appointments booking system, whereby patients can choose and book a GP.

But the report added it was unclear why there had been a lack of progress in moving care out of hospitals as more and more GPs were being trained to provide ever more complex care.

Healthcare Commission chairman Sir Ian Kennedy said the controversial polyclinic model, which is set to be rolled out across the country, could provide a "radical" solution to the problem.

On the wider problem of progress, he said the "building blocks" were in place.

But he added: "It's clear that the reforms have not yet achieved what was promised and that progress is behind what some might have hoped at his point."

Anna Dixon, of the King's Fund health think-tank, said the reform programme had reached a "critical point".

A Department of Health spokesman said it was a "balanced and helpful" report which confirmed the government "should press on with these policies rather than changing tack".

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