Reforming the health system: local experiences

The project is based primarily on qualitative interviews in six case study sites. Within each site we are examining the impact the reforms have had on three service areas. These three service areas were chosen to reflect a range of services which may be expected to be affected differently by the reform programme:

• Orthopaedics – an elective service that is at the forefront of the choice agenda and available in some areas in independent treatment centres.
• Diabetes – a chronic condition with a high preventative aspect and requiring a more managed and co-ordinated response, potentially commissioned and provided in partnership with local authority services.
• Early intervention mental health – a service where patient choice is less relevant, but where partnership working between health and social care is higher.

We have interviewed more than 150 stakeholders, including clinicians, commissioners, and representatives from NHS and independent sector provider organisations. Qualitative analysis of this interview data has been supported with analysis of quantitative data from the six sites.

Our analysis focuses on the way in which the reforms have been implemented in the six case study sites; the impacts on service delivery within the three service areas; and the factors which account for contrasting experiences between the different sites and service areas.