The UK's system for paying hospitals and measuring NHS performance is being put under the microscope to see if it actually works. This matters because the way the NHS pays hospitals—through a system called Payment by Results—directly shapes how care is delivered, how long patients wait, and where they can choose to be treated. The research also examines how local health commissioners (PCTs) decide which providers to use, and whether patient choice policies actually give people meaningful options. Without rigorous evaluation, policymakers risk designing incentives that produce unintended consequences, such as hospitals avoiding expensive patients or waiting lists shifting rather than shrinking. If this research succeeds, it could lead to smarter payment systems that reward quality rather than just activity, more accurate measures of NHS productivity, and a clearer understanding of whether patient choice improves outcomes or simply redistributes demand. The work also models how commissioning patterns change over time, which helps predict the effects of introducing independent sector providers. These are technical, behind-the-scenes systems—hospital finance, waiting time targets, and performance metrics—that quietly determine whether the NHS runs efficiently or wastes billions. The project is applied policy research, not fundamental science, and its impact depends on whether the Department of Health acts on the findings.
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BackgroundThe following areas have been identified as of current interest but the portfolio of work undertaken over the 5 year period will reflect prioritisation between these (and/or additional) options. 1 Research on Payment By Results will continue to build on work conducted on the programme to date and on pilot work currently underway in South Yorkshire Strategic HA in 2005. Our contribution has taken and - it is hoped - will continue to take a number of forms, including involvement in the technical aspects of payment design, evaluation of policy, and appraisal of additional instruments to support policy objectives. Our research is intended to complement rather than overlap with the commissioned project on PbR from HERU, Aberdeen. We are currently liaising with members of the PbR team in the Department of Health about taking forward research in this area.2 The programme has previously involved work on various aspects of performance measurement, including the modelling of waiting times. Subject to suitable project definition, research into waiting times or other aspects of performance measurement and targets may continue.3 Research on measuring NHS outputs and productivity may continue on the programme after the current project ends in September 2005. Continuation would be subject to a suitable research project being defined and agreed. This would necessitate involving other stakeholders, such as the ONS, in drawing up a precise definition of what work would best be undertaken on the programme.4 We propose to continue with our existing research into primary care commissioning patterns, which we have conducted jointly with Hugh Gravelle, Manchester NPCRDC. To date the work has focussed on examining the baseline position in relation to the use of different providers by PCTs over time. Future commissioning patterns will be subject to various influences, including practice based commissioning, payment by results, patient choice and independent sector providers. As HES data become available for future years, we will be able to map and explain changes in use of providers and model purchaser-provider relationships.5 The patient choice agenda is a central plank of government policy, and includes offering choice of 4-5 NHS and independent sector providers by 2008 and, potentially, extending choice to that of primary care provider. CHE conducted the London Patient Choice Evaluation, funded by the DoH separately from the programme. We are well-placed to provide a theoretical framework for the design and evaluation of policy relating to choice, and to conduct further empirical research into the issue. This would require negotiation about the form that a research project might take. AimsHISTORIC PROJECT - Entire abstract transferred from the previous database into the [Scientific summary background] field of this database.Plan of InvestigationHISTORIC PROJECT - Entire abstract transferred from the previous database into the [Scientific summary background] field of this database.Potential ImpactHISTORIC PROJECT - Entire abstract transferred from the previous database into the [Scientific summary background] field of this database.Policy RelevanceUnkown
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