Raising Standards
Health services is another area where governments in the English-speaking world have sought to use performance measurement and reporting as a means of driving through reform. The UK government has been measuring and benchmarking performance in the National Health Service for more than a decade.
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Improving Performance Through Outcomes (Web Page) Geoff Watts, John Black, Bruce Keogh, David Taggart, David Neal, Mike Parker, Penny Woods, David Cromwell, Tim Stokes, Mark Davies, Alberic Fieens & Richard Welbourn, Mike Richards., 2011 Royal College of Surgeons
At this RCS seminar professional medical associations, patient representatives and health economists presented on performance and outcome measurement in health care. All presentations are available on video via this link.
UKCommissioning: Further issues (PDF) House of Commons Health Select Committee, 2011 The Stationery Office
This report examines in further detail issues raised in previous Health Select Committee examination of commissioning in the sector.
UKImplementing GP Commissioning (PDF) Eve Norridge, 2011 Policy Exchange
This report explores possible implementation models for GP consortia and critical factors for the success of the planned abolition of Primary Care Trusts by April 2013 and transfer of responsibility for NHS commissioning to GP consortia. It is based on interviews with the GP leaders or managers of 16 'pathfinder' consortia and with other experts, as well as a Policy Exchange round table.
UKNational Programme for IT in the NHS: An update on the delivery of detailed care records system National Audit Office (NAO), 2011
This report finds that the rate at which electronic care records systems are being put in place across the NHS under the National Programme for IT is falling far below expectations and the core aim that every patient should have an electronic care record under the Programme will not now be achieved.
It Can Be Done: Case studies of successful private sector involvement in education, health, policing, and prisons reform (Web Page) Dale Bassett, Andrew Haldenby, Nick Seddon, Will Tanner, Kimberley Trewhitt, 2011
This report assesses the case for supply-side competition in the UK health sector. It demonstrates that for-profit companies are delivering public services across core sectors in the UK and overseas; it argues that they are providing better value and has strengthened the fabric of its fields in doing so.
UKNational Health Service Landscape Review (PDF) Public Accounts Committee (PAC), 2011 The Stationery Office
This report provides an overview of aspects of proposed health and social care reforms and draws out a number of risks associated with the transition to the new model that need to be managed.
UKWhere next for the NHS reforms? The case for integrated care (Web Page) Chris Ham, Candace Imison, Nick Goodwin, Anna Dixon, Patrick South, 2011 King's Fund
This paper sets out the challenges facing the NHS and identifies the reforms the authors believe are needed to meet these challenges. They offer suggestions for revisions to the current Bill and future policy development and also lay out a more radical model that they claim holds the prospect of greater progress towards the vision of integrated care and a health system sustainable in the longer term.
UKNHS Reforms in England: Managing the Transition (Web Page) Nuffield Trust, 2011 This paper assesses the 2011/12 Operating Framework for the NHS together with guidance on the operation of Payment by Results in 2011/12. It sets out the key challenges associated with managing the transition to a reformed NHS, as envisaged in the White Paper: Equity and Excellence: Liberating the NHS, and proposes ways in which the risks associated with transition might be mitigated. UK
Reconfiguring Hospital Services: Lessons from South East London (Web Page) Keith Palmer, 2011 The King's Fund This report considers whether reconfiguration of hospital services is an appropriate response to the need to drive up quality and drive down costs. It highlights that market forces alone are insufficient to drive up improvements in quality of care and examines how commissioning and service-consolidation can improve quality of care. UK
Social Enterprise Spin-Outs from the English Health Service: A right to request but was anyone listening? (Web Page) Robin Miller and Dr Ross Millar, 2011 Third Sector Research Centre The 'Right to Request' initiative was introduced in 2008 as a process through which NHS clinicians and managers working in England could seek to develop a social enterprise to deliver Community Health Services. This paper reflects on the experiences of these clinicians and managers, and the response of the local health systems in which they work. UK
Paying GPs to Improve Quality Audit Commission, 2011
This paper examines one element of the Department of Health's Quality and Outcomes Framework (QOF). It focuses on how primary care trusts (PCTs) discharge their duty to ensure payments are properly made and in doing so can be certain that the right patients are being provided with the right services under the QOF, challenging practices where this is not the case.
Clinical and Service Integration: The route to improved outcomes Natasha Curry and Chris Ham, 2011 King's Fund This paper argues that closer integration of care in the English NHS should continue. Organisational integration alone is unlikely to deliver better outcomes and effort must focus on clinical and service integration. Action is needed at the macro, meso and micro levels, and multiple strategies should be pursued at all three levels.
Comissioning (PDF) House of Commons Health Committee, 2011 The Stationery Office The latest Committee report into commissioning in the NHS. It sees commissioning as a potentially effective instrument to drive innovation, quality and value. UK
NHS White Paper Proposal for GP Commissioning: Does size matter? (PDF) Sebastian Baird, James Gubb, Kieran Walshe, 2010 Civitas This report looks at the relationship between size and performance in commissioning organisations both in the NHS in England and internationally, using original data analysis and a literature review. UK
Management in Healthcare: Why good practices really matter (PDF) McKinsey & Company, 2010 London School of Economics Centre for Economic Performance (LSE CEP) This report covers healthcare management practices across three broad areas - operational processes, performance management and people management - in nearly 1.200 hospitals in seven countries: the UK, the United States, Canada, France, Germany,Italy and Sweden. It finds that good management is demonstrably key to performance, delivering lower mortality rates and more satisfied patients at a lower cost. Crucially, key factors in improving management standards are competition and autonomy. UK
Practice Makes Perfect (Web Page) Paul Corrigan, 2010 Demos This pamphlet investigates the example of NHS Cumbria, where GP-led consortia have been in development since June 2009, using it as a case study of the future of the NHS, which is phasing out Primary Care Trusts (PCTs) in favour of GP-led commissioming. UK
'Equity and Excellence: Liberating the NHS' (Web Page) Department of Health, 2010
The new White Paper sets out the UK Government's long-term vision for the future of the NHS. It adopts an outcome-centred approach, acknowledging that outcomes matter most to patients and liberating clinicians to focus on improving healthcare outcomes.
UKImproving Health Outcomes: A guide for action (PDF) 2020 Public Services Trust, 2010 Royal Society of Arts This report attempts to lay out a coherent, long-term approach to health and social care reform by taking an outcomes-based view. It shows how policy might be adapted to embrace shifts in culture, power and finance in public service delivery, acknowledging as well the significant economic challenges that policymakers face. UK
Patient Choice: How patients choose and how providers respond (PDF) Anna Dixon, Ruth Robertson, John Appleby, Peter Burge, Nancy Devlin, Helen Magee, 2010 King's Fund
This is a collaborative report written in partnership with RAND Europe, Picker Institute Europe and the Office of Health Economics. It considers how free choice of provider is operating in practice and what impact patient choice is having on hospital providers.
UK
The Performance and Management of Hospital PFI Contracts (Web Page)
National Audit Office, 2010
A report about the performance of the maintenance and support services under the operational phase of PFI contracts.
UK
Building high quality commissioning: What role can external organisations play? (Web Page) Chris Naylor; Nick Goodwin, 2010 King's Fund
This report examines how external support is being used by primary care trusts and strategic health authorities and whether it is helping them to develop more effective commissioning. It finds that commissioning is now standard NHS practice and yields benefits, though there is room for further improvement.
UKBest of Health: Improving Lives Through Smarter Care (PDF) CBI Public Services and Skills Directorate, 2010 Confederation of British Industry (CBI) This report examines the changing face of health sector delivery. Against a backdrop of budget restriction, demographic change and lifestyle choices which are altering patient needs new treatments and practices emerge all the time. The authors argue the case for doing more with less: earlier diagnosis and prevention; treatment in the community; change management engaging staff in service design. UK
Hopsital Care at Home: Supporting Independent and Healthy Lives (PDF) Dr Foster Intelligence/Healthcare at Home Ltd, 2010 This report explores how home-based healthcare models could improve outcomes and patient experience while yielding savings of £540million-£1.2billion. UK
Management Practices in the NHS (PDF) Bloom, Nick; Propper, Carol; Seller, Stephan and Van Reenen, John, 2010 Centre for Economic Performance, London School of Economics This summarises a study of clinicians and hospital managers exploring how well NHS hospitals are managed and how this management can be improved - with particular awareness of the impact of competition between hospitals. A key finding is that competition stimulates better management and higher productivity. UK
Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After (PDF) Sheelah Connolly, Gwyn Bevan, Nicholas Mays, 2010 Nuffield Trust After 1999 political devolution across the United Kingdom, there developed four parallel models of National Health Service provision in England, Scotland, Wales and Northern Ireland. This report represents the first comparative analysis of these four 'National Health Services', finding that England has the highest productivity thanks in part to improved benchmarking, efficiency and use of incentives. ISBN: 1-978-1-905030-40-8 UK
Payment by Results Data Assurance Framework 2008/09 (PDF) Audit Commission, 2009 This report presents the key findings and analysis of the 2008/09 national clinical coding audit programme managed by the Audit Commission under the Payment by Results (PbR) Data Assurance Framework. It shows that the number of errors made by NHS trusts under PbR is falling. UK
Shaping PCT Provider Services: The Future for Community Health (PDF) Imison, Candace, 2009 The King's Fund This report examines the challenge of better integrating community health services with hospital and GP care and improving service delivery through commissioning based on quality and value for money. UK
Patient Power (PDF) Thomson, Ben and Mawdsley, Geoff, 2009 Reform Scotland A report which puts forward reforms for greater patient choice in Scotland's health services based on analysis of European systems of social insurance. UK
Foundation Trusts and Monitor (PDF) House of Commons Health Select Committee, 2008 The Stationery Office NHS foundation trusts were first established in 2004 to improve local accountability and management efficiency through devolved power. Up to the end of 2008 over 100 such trusts have been established but this report is the first systematic analysis of their impact. HC 833-I UK
High Quality Care for All: NHS Next Stage Review (Web Page) Lord Darzi, 2008 Department of Health This report is a wide-ranging examination of the UK's National Health Service, making an extensive series of recommendations for the future direction. It advocates a locally-led, patient-centred service with quality as its priority. Freedom to focus on delivering this quality is highlighted as essential: devolving power to front-line staff. ISBN 978-0-10-174322-8 UK
A Healthy Choice: Building a Stronger NHS (PDF) CBI, 2008 A report on improving the quality and efficiency of the NHS through patient-focused reforms. It suggests that commissioners must become the key players in promoting innovation, choice and faster access to healthcare through fair market managment. ISBN 978-0-85201-685-5 UK
Is the Treatment Working? Progress with the NHS System Reform Programme (PDF) Healthcare Commission & Audit Commission, 2008 An assessment of the major NHS reforms since 2000. The report looks at the impact of Payment by Results, patient choice, practice-based commissioning, foundation trusts, Independent Sector Treatment Centres and workforce contractual changes. UK
Delivering Some of the Best Health in Europe: Outcomes not Targets (PDF) Conservative Party Policy Green Paper, 2008 This paper proposes the replacement of top-down, process driven targets with a new accountability mechanism that promotes patient choice based on publcily available information on local health outcomes. UK
NHS Reform: National Mantra, Not Local Reality (PDF) Bosanquet, Nick; Haldenby, Andrew; Rainbow, Helen, 2008 This report argues that while the NHS is in need of the government's professed reform, the government is in denial about its progress on the ground. It suggests that reform is the only way to unlock the value of the NHS budget but the government's programmes remain embryonic, and in some cases in full retreat. It proposes that the solution is an economic constitution which defines duties to create value at all levels of the NHS. UK
The Right Result? Payment by Results (PDF) Audit Commission, 2008 This report examines the NHS's experience with Payment by Results. It finds that hospitals are paid the same for a procedure regardless of the quality of care provided and recommends that the NHS consider rewarding those hospitals that meet the highest standards of quality for patients. UK
ISTCs and the NHS: Sticking Plaster or Real Reform? (PDF)
Confederation of British Industry, 2008
This report examines the record of Independent Sector Treatment Centres (ISTCs), the elective and diagnostic care units encouraged by the UK government. It finds that ISTCs are an NHS success story and that changing NHS behaviour and expanding patient choice will bring further benefits.
Independent Sector Treatment Centres: Evidence So Far (PDF)
Pollock, Allyson M and Godden, Sylvia, 2008
A paper assessing the evidence on ISTC performance in the first two waves of the programme. It found that due to a lack of data collected or provided by the Department of Health it was not possible to determine any changes in value for money or quality of care.
UK
Measure for measure: Using outcome measures to raise standards in the NHS (PDF) Hamblin, Richard; Ganesh, Janan and Lockhart, Gavin (ed.), 2007 Policy Exchange This report examines the ways in which the provision of more and better information about the quality of health services to the public may lead to an increase in the quality of healthcare generally. Through a comparative analysis of different types of measurement schemes in Britain and the US and the qualities that make them successful, the report makes recommendations for policy reform in this area leading to increased accountability, patient trust and overall performance. UK
Public Services at the Crossroads Brooks, Richard (Ed.), 2007 Institute for Public Policy Research (ippr) This report argues that UK public services in 2007 are "at a crossroads" with a new government offering the opportunity to steer a new course in reform. It focuses on the health, education and criminal justice sectors to outline "a progressive agenda" in which social justice is placed at the heart of public service policy. It is cautiously optimistic about the role played by (quasi-)markets in public services, arguing that the principle reason for private and voluntary sector involvement "is not the inherent superiority of one type of provider over another, but rather the opportunity that such diversity offers to generate competitive pressure for improvement among providers from all sectors". ISBN: 978-1-86030-315-9 UK
Just What The Patient Ordered: Better GP Services (PDF) Confederation of British Industry (CBI), 2007 The CBI report sets out recommendations to General Practioners for patient choice, better GP services and improvements across the NHS, outlining the need for an effective, responsive and properly funded National Healh Service and states that in order for GP service improvements to be made, patients must be in the driving seat. ISBN: 978-0-85201-670-1 UK
A Rational Way Forward for the NHS in England (PDF)
BMA Working Group, 2007
British Medical Association (BMA)
This report aspires to setting out a rational way forward to secure the long-term future of the NHS in England. First it outlines where and why the current reform programme is "going wrong". Then it outlines the BMA's "rational way forward" for health service reform in England. Key recommendations include greater independence for the NHS, and the establishment of a set of core services to be provided universally with rationing on supplementary services.
NHS Autonomy and Accountability: Proposals for Legislation (PDF)
Conservative Party (UK), 2007
This Conservative Party White Paper proposes legislation to "free the NHS from day-to-day interference by politicians" while remaining accountable, democratic and needs-based. It proposes an independent NHS board, the abolition of certain targets and greater autonomy for primary care commissioners and trusts, but was criticised for failure to depart further from the centralised post-WWII model.
An Independent NHS: A Review of the Options (PDF)
Edwards, Brian, 2007
The Nuffield Trust
This report analyses the options for establishing independence for the NHS, and those options' respective costs and benefits. All ideas are in line with the service's founding principles - available on the basis of need, and paid for by taxation - and take account of recent increases in private and voluntary sector involvement, but at the same time aim to propose a new governance paradigm.
Funding Health Care: 2008 and beyond (PDF) Appleby, John (Ed.), 2007 King's Fund This paper summarises the discussions and conclusions of a King's Fund conference on health care funding. Contributions cover not only the source of funding but the processes and framework by which this ought to be achieved. Five key recommendations are made: (i) measure what counts, (ii) reduce variations in performance, (iii) improve productivity, (iv) design effective incentive systems, and (v) engage clinicians. ISBN 978 1 85717 553 0 UK
The Provision of Out-of-Hours Care in England (PDF)
Public Accounts Committee (PAC), 2007
The Stationery Office
This report examines the impact of the Government policy to raise standards in out-of-hours care by allowing GPs an opt-out and placing responsibility for this care with the local Primary Care Trust. While services have begun to improve, the report is scathing in its verdict on the preparation, performance and costs resulting from the policy shift.
Dr Foster Intelligence: A Joint Venture between the Information Centre and Dr Foster LLP (PDF) Public Accounts Committee, 2007 Stationery Office HC368 This report follows up on an earlier NAO report on the joint venture between the Department of Health information centre and Dr Foster LLP, a private company specialising in data dissemination. It re-affirms earlier findings that the public-private partnership has not delivered. In particular the report stresses that the apparent favouritism in procurement represents a disregard for both best practice and the rules governing the use of public money. UK
Dr Foster Intelligence: A Joint Venture Between the Information Centre and Dr Foster LLP (PDF) National Audit Office (NAO), 2007 This report examines the joint venture between the Department of Health information centre and Dr Foster LLP, a private company specialising in data dissemination. The aim of this partnership was to improve strategy through heightened data analysis and application. However, it is found that the DoH cannot demonstrate optimal value-for-money improvements, primarily because the contract did not go out to tender to encourage fair competition. UK
The Future Hospital: The Politics of Change (PDF)
Farrington-Douglas, Joe with Brooks, Richard, 2007
Institute for Public Policy Research (IPPR)
This report analyses the politics and process of hospital change at a local level, seeking to improve these mechanisms to raise standards of care. The findings and policy recommendations are based on a combination of case studies, theoretical framework-building and stakeholder interviews.
Investment and Reform: Transforming Health Care (Web Page) Hewitt, Patricia, 2006 London School of Economics (LSE) This speech explains how New Labour's health sector reforms are intended to create a patient-led NHS, where improvements to standards of healthcare are driven by patients not politicians. The then Secretary of State addressed issues such as use of the private sector to deliver NHS services, greater choice for patients, and getting efficiency, productivity and better value for money. UK
Charging Ahead? Spreading the Cost of Modern Public Services (Web Page)
Asato, Jessica (Ed.), 2006
Social Market Foundation (SMF)
This collection of essays discusses whether there is a case for introducing or extending co-payments in UK public service provision. It considers the economic and political principles that underpin the use of co-payment in UK public services, and in particular the impact on equity. The potential for extending co-payment or introducing new charges is investigated in three sectors: health, higher education and local government. The full publication can be downloaded via this web page link.
UK
The Provision of Out-of-Hours Care in England (PDF) National Audit Office (NAO), 2006 The Stationery Office This report examines the Department for Health's progress in providing high-quality out-of-hours services. In particular it looks at the effect of General Medical Services contracts, which allowed GPs to opt out of the responsibility of organising out-of-hours care entirely from 1 April 2004. It finds that there is considerable room for improvement but that services are getting better. This report was followed by the PAC report of the same name, which is also available on the Resource Centre. HC 1041 UK
Spending on Health Care - How much is enough? (PDF) Appleby, John and Harrison, Anthony, 2006 King's Fund The Blair Government raised health spending to record levels between 1997 and 2006. Given this empirical fact and the expectation that at some point the marginal returns on investment must diminish, this report attempts to define a desirable limit on health spending. In addition, it asks what evidence ought to inform such a decision given that it has political as well as economic dimensions. ISBN 1 85717 543 3 UK
Assessing the New NHS Consultant Contract: A Something for Nothing Deal? (PDF)
Williams, Sally and Buchan, James, 2006
King's Fund
This report examines the new NHS consultant contract, which was intended to increase productivity through more flexible working hours and better-motivated workers. It draws on a literature review as well as interviews and case studies to deliver a critical verdict - benefits are not yet being realised - as well as recommendations to improve future performance.
Will More Choice Improve Outcomes in Education and Healthcare? The Evidence from Economic Research (PDF)
Burgess, Simon, Propper, Carol and Wilson, Deborah, 2005
Centre for Market and Public Organisation (CMPO)
To the Point: A Blueprint for Good Targets (PDF)
Targets Commission, 2005
Social Market Foundation (SMF)
Measuring NHS Success (PDF)
Appleby, John and Devlin, Nancy, 2005
King's Fund
This research asks whether routinely measuring patients' health outcomes through patient questionnaires would help the health service to self-evaluate more effectively. It examines the costs of implementing such a system and asks whether it would be cost-effective in the long run.
Road Map to Reform: Health (PDF)
Goldsmith, Michael, and Gladstone, David, 2005
Adam Smith Institute (ASI)
This report is the second in the ASI's 'Road Map to Reform' series seeking to promote a new strategy for diversity and competition across government and public services. The authors argue that the best of the NHS can be retained under public-private co-operation, espousing a new model which will unleash innovation and enterprise in healthcare provision.
An Independent Audit of the NHS under Labour (1997-2005) (PDF)
King's Fund, 2005
This briefing paper was commissioned by the Sunday Times newspaper to assess the New Labour Government's attempts during their first two terms of office to fulfil their promise "to save the NHS". Overall, the verdict is positive with more and better services realised through increased spending and central targets. However, there are still important problems to be solved and it is too early to predict whether market incentives coupled with regulation will bring about the desired improvements.
Incentives for Reform in the NHS: An Assessment of Current Incentives in the South-East London Health Economy (PDF)
Grant, Jenny, 2005
King's Fund
This report assesses the role of incentives in raising standards in the health sector, taking the South-East London region as a case study. Through interviews with stakeholders the paper examines the impact of incentives and makes a number of recommendations to refine incentivisation processes at both national and local levels.
ISBN 978 1 85717 532 5
UK
Private Payment for Health: Boon or Bane? (Web Page)
SMF Health Commission, 2004
Social Market Foundation (SMF)
This report argues that the role private payments could play in health care has often been hindered by over-simplistic ideology and that partial exit from a monopolistic state provider has encouraged excellence in provision, paving the way for health care that is more responsive to individual patients. It also argues that the economic arguments for encouraging employers to pay more towards health care are more powerful than those for individual tax relief. It does not advocate policy change but argues that private payments ought to be recognised as an important factor in NHS financing. The full report can be downloaded via this web page link.
User Charges for Health Care (Web Page)
SMF Health Commission, 2004
Social Market Foundation (SMF)
This paper reviews the advantages of user-charges in health care, including driving more efficient services, making providers more accountable for service quality and promoting patient choice. It also concedes disadvantages of charges, such as the possibility of inefficiency, lack of fairness and high administration costs. The full report can be downloaded via this web page link.
Can Market Forces Be Used For Good? (PDF) Dixon, Jennifer; Le Grand, Julian; Smith, Peter, 2003 King's Fund This paper asks whether a highly centralised healthcare system can sit comfortably alongside a market-led approach, and whether market forces can respond effectively to meet the demands of the UK's ageing population. It is comprised of the views of three experts: Le Grand writes on stronger market incentives for secondary care providers; Smith argues against even modest experimentation with stronger market incentives; and Dixon looks at the plausibility of combining the best aspects of market disciplines with planned provision. ISBN 1 85717 477 1 UK
Partnerships for Health (PDF)
Butler, Eamonn, 2002
Adam Smith Institute (ASI)
This ASI briefing paper argues that real improvements in UK healthcare can most effectively be achieved through a broader policy scope encouraging "real partnerships" between the NHS, the private sector and patients themselves.
Innovation in the National Health Service - The Acquisition of the London Heart Hospital (PDF)
National Audit Office (NAO), 2002
The Stationery Office
This report examines the NHS's innovative, risk-aware acquisition of the Heart Hospital in London. It commends the project's work to date and makes recommendations for the Heart Hospital's continued progress as well as drawing out wider conclusions for NHS acquisitions and Department of Health management.
Report on Government Services 2002 - Part C: Health (PDF)
Productivity Commission, 2002
This report was produced by the Steering Committee for the Review of Commonwealth/State Service Provision (SCRCSSP). This link is through to 'Part C: Health', which analyses the performance of publicly-funded hospitals and general practitioners (GPs) with efficiency data.
Australia
The New Shape of Public Services Volume I: Health and Education (PDF)
Butler, Eamonn and Pirie, Madsen, 2001
Adam Smith Institute (ASI)
This report outlines a new vision for the NHS and state education, aiming to make both markets more innovative and consumer-focused. "Free-standing, self-owned and independent" providers would manage their own budgets and set their own policy and priorities. Driven by the demands of their customers, public services would utilise this autonomy to improve quality and efficiency.
Paying for Medicines (PDF)
Senior, Ian, 2001
Adam Smith Institute (ASI)
This report suggests that Britain should follow Sweden, Norway, Holland and Belgium in asking people to pay their first £60 in annual prescription bills. This would bring an extra £2 billion into the NHS and cut the waste of 'free' medicines that are never taken. It would also allow patients to weigh up whether expensive new medicines - unavailable on the NHS today- were really worth paying for.
Inappropriate Adjustments to NHS Waiting Lists (PDF)
National Audit Office (NAO), 2001
The Stationery Office
This report follows up on 'Inpatient and Outpatient Waiting in the NHS' (NAO, 2001), which found six NHS trusts where waiting lists had been inappropriately adjusted. It highlights a further three trusts in which waiting list reporting is a problem and makes a series of recommendations for future investigation and clarification of such irregularities.
The World Health Report 2000-Health Systems: Improving Performance (PDF) World Health Organisation, 2000 This report gives information on assessing and improving health systems. It looks at their performance and goals and the different methods used to finance these systems. Findings from the report show that governments tend to focus too much on the public sector, disregarding private provision of care. ISBN 92 4 156198 X
What A Performance: Performance Related Pay In The Public Services (PDF)
French, Stephen; Marsden, David, 1998
Centre for Economic Performance, London School of Economics
This report is among the earliest studies to examine performance-related pay schemes in the public services. It examines data from the Inland Revenue, the Employment Service, NHS Trust Hospitals and Head Teachers and finds that while performance-related pay can increase productivity it can also foster distrust and feelings of injustice among workers.
The Health Alternatives (PDF)
Pirie, Madsen and Butler, Eamonn, 1988
Adam Smith Institute (ASI)
This ASI report considers potential improvements to management of the NHS. It suggests evolutionary rather than revolutionary reform, to be achieved through the judicious use of competition, choice and incentive. The authors argue their reforms can improve the efficiency with which healthcare is delivered while safeguarding the NHS's major achievements.
Managing Better Health (PDF)
Goldsmith, Michael and Pirie, Madsen, 1988
Adam Smith Institute (ASI)
This report attempts to draw out the lessons from managed healthcare systems in use in the USA with a view to application in Britain. It suggests that a restructured management system with greater emphasis on choice and incentives would bring significant improvements for the NHS.