Reforming the health system: local experiences

In brief

Since 2002, the Department of Health has introduced a number of reforms that have sought to change the way the NHS operates in England. These reforms aim to improve the quality of care received by patients and to deliver better value for money.
The reforms introduced can be arranged into four streams:

Demand-side reforms: choice and a stronger voice for patients, and an increased emphasis on how health services are commissioned.
Supply-side reforms: using a wider range of providers, including NHS foundation trusts and independent sector providers.
Transactional reforms: a new payment system, Payment by Results, where money follows the patient with specific rewards and penalties linked to meeting key markers of quality.
System management reforms: for example, changes to the regulatory framework.

The Department of Health has commissioned evaluations of these reforms through the Health Reforms Evaluation Programme (HREP).
As part of the HREP programme, The King’s Fund is working with partners in the University of Birmingham to explore the combined impact of these reforms. Our research examines how the reforms have played out in different geographical and clinical areas; how local context has influenced implementation; and whether the reform levers work together coherently to improve patient care and drive value for money.
Objectives of the research include:
- To explore how the reforms are being implemented at the local level, and how the various elements of the reform programme are interacting with each other.
- To identify the extent to which the reforms are proving effective in addressing specific local issues, such as service reconfiguration and finance issues.
- To provide policy-makers and practitioners with feedback on good practice in implementation.