The NHS Plan: Accounting for investment and reform in twenty acute hospital trusts in England (1998–2003)

The National Health Service (NHS) Plan published in 2000 summarised Labour's commitment to modernising the NHS in England. The NHS would receive substantial additional funding bringing expenditure on health, as a share in national income, to levels comparable with a European average. The promise of secure financing from government promised to reduce uncertainty and facilitate medium term resource planning in the NHS. Extra funding, as outlined in the NHS Plan, would also be tied into capital and labour process reform(s) to ensure that investment translated into the much needed additional capacity to treat patients. During the period 1998–2003 funding for an average acute hospital has increased 50% in cash terms satisfying expectations set out in the NHS Plan. It is now an appropriate time to review progress. Using information collected for 20 acute hospitals, selected on the basis that they had started and completed PFI projects in the period 1998–2003. This paper constructs a physical and financial audit which is then used to reveal the degree to which acute hospital finances are now secure and the extent to which physical capacity to treat patients has been robustly transformed.     

Appraising and Evaluating PFI for NHS Hospitals

This paper explores the use of appraisal in the development of proposals to use private finance to provide acute hospitals under the Private Finance Initiative (PFI). It addresses the extent to which value for money (VFM) and affordability (which must be satisfied to enable a scheme to be approved) are demonstrated in the documents prepared by hospital Trusts. It identifies a number of issues (such as the transfer of risk and the development of public sector comparators) that pose new problems for investment appraisal, which are specific to its application to PFI.     

ASSESSING CAPITAL CHARGING IN THE NATIONAL HEALTH SERVICE

Capital charging was introduced into the NHS in 1991, as one of the components of the internal market reforms. Having established context and rationale, this article reviews published surveys of capital charging. It then reports the results of a questionnaire survey conducted in 1994 which probed the views of finance and estates staff in NHS provider units in Scotland as to the efficacy and effects ofcapital charging. Strong support for the principle of capital charging was found, despite considerable evidence of implementation difficulties which had differentially impacted upon Health Boards. Respondents expected that the effects of capital charging would be lower investment and higher disposals, thus leading to a smaller NHS estate.     

The price of fear: Estimating the financial cost of bullying and harassment to the NHS in England

Using a spectrum of measures, this paper estimates some of the financial costs of bullying and harassment to the NHS in England. By means of specific impacts resulting from bullying and harassment to staff health, sickness absence costs to the employer, employee turnover, diminished productivity, sickness presenteeism, compensation, litigation and industrial relations costs, we conservatively estimate bullying and harassment to cost the taxpayer £2.281 billion per annum.     

THE SEARCH FOR A PROPORTIONATE CARE LAW BY FORMULA FUNDING IN THE ENGLISH NHS

Although the National Health Service was created to achieve equity of access to health care in 1948, over twenty years later an 'inverse care law' was seen to operate. The 1976  Report of the Resource Allocation Working Party  laid the principles of formula funding to achieve an equitable distribution of resources, to move, over time, towards the operation of a proportionate care law. These principles have been applied ever since in England. This paper describes the context, governance and subsequent development of formulas and three persistent problems: accounting for populations, their needs and variations in the unavoidable costs of providers. The paper concludes by outlining continuing problems from the past and new challenges of formula funding in England to reduce 'avoidable' inequalities in health.     

Service line reporting in a National Health Service foundation trust: an initial assessment of its relevance and applicability

Financial management and control systems are key components of effective management in NHS organizations. Systems have recently been enhanced by the introduction of service line reporting (SLR) in NHS foundation trusts (NHSFT). This article explores the extent to which SLR has been introduced into one NHSFT and what achievements have been made so far. It also considers the extent to which the SLR approach aligns with modern thinking about budgetary systems.     

New development: Spin-outs and social enterprise: the ‘right to request’ programme for health and social care services

The ‘right to request’ policy encouraged and supported National Health Service (NHS) community health staff in England to ‘spin out’ services into independent social enterprises. This article considers the processes and outputs of the initiative and reflects on the likelihood of positive outcomes for patients being achieved. It highlights lessons for future programmes seeking to transfer services out of public ownership.     

Research article: Look after they leap: illustrating the value of retrospective reports in employee turnover

The prevailing methodology for studying employee turnover is limited because it emphasizes prediction rather than understanding. This paper critiques this methodology and draws out the implications of an alternative: retrospective self-reporting, by actual leavers. Retrospective self-reporting has three main advantages. First, it allows direct assessment of actual incidents of turnover, so interventions can be informed by accounts of real events, instead of being based on inference. Second, it offers insight into the dynamic character of decisions to quit, which are often unpredictable or precipitated by sudden events. Third, it allows for assessment of the role of non-work factors. This makes a methodological contribution, allowing greater insight into the decision to quit, which is ontologically, socially and dynamically complex. It has implications for how we construe and manage turnover. The argument is illustrated by a recent study of 352 UK National Health Service nurse leavers but has wider implications for turnover in the public sector.     

The long shadow of public policy; Barriers to a value-based approach in healthcare procurement

Procurement in the UKs National Health Service (NHS) is facing its most significant financial challenge. Despite the sheer scale and complexities of the public healthcare sector, the Government's solutions are all too often packaged as "collaborate more", "standardise products" and "leverage spend". Unfortunately, these over simplistic solutions take a myopic view of market drivers, conflate spend with potential savings and fail to deliver value. Many contracts have already been commercially optimised yet the funding crisis continues to deepen. New value-based procurement approaches are needed to drive longer-term innovation and cost reduction and to move debates from efficiencies to embrace effectiveness in integrated supply chains. In this research, we adopt the resource-based view (RBV) as a lens to explore the extent to which NHS resources support the strategic adoption of value-based approaches. An empirical case study on a regional cluster of six NHS Trusts in England, confirms the dominance of narrow price-based approaches that create barriers to moving towards longer-term, valuebased procurement. The antecedent roots of price-based approaches are unpicked through a hermeneutic analysis of recent Government commissioned reports to show how these have set the tone, culture and priorities for healthcare procurement in the UK. The analysis provides explanatory power to the case study by illustrating how Government reports have led to, and legitimised the dominance of price-based approaches and caused relational and resource-based barriers to adopting value-based procurement, despite stakeholder enthusiasm. The findings provide unique insights into why public procurement has struggled to reach beyond its traditional cost orientated scope. We contribute to an extended consideration of the RBV in public organisations through identifying the role of the policy environment in determining and legitimatising an organisation's strategic direction.     

Commissioning and GPs: to commit[tee] or not?

Clinical commissioning groups (CCGs), part of the UK's National Health Service (NHS) since April 2013, are complex organizations requiring buy-in by GPs for strategic success. CCG budgetary deficits and lack of sustained engagement by GPs are a problem. This paper utilizes evidence of GP experience in commissioning models to determine the factors that may influence engagement in the governance of CCGs by GPs, which is crucial if clinically-led commissioning is to be part of a financially sustainable NHS.