Autonomy and performance in the public sector: the experience of English NHS hospitals

From April 2016, Monitor has changed its name to NHS Improvement.

An example of this approach is the paper by Propper et al. [24], which investigates the impact of the general practitioner (GP) fundholder scheme on hospital waiting times in the UK NHS. The fundholder policy is similar to the FT policy in several ways (e.g., it was voluntary and practices joined the scheme at different times), hence the methodological approach takes these factors into account.

Both for-profit and not-for-profit independent providers are excluded from our analysis, which refers to public hospital Trusts only.

Like Diagnosis Related Groups (DRGs), HRGs contain clinically similar treatments with similar costs. All inpatient elective and non-elective schedules used for the reference cost dataset are based on data truncation, excluding bed days that fall outside of nationally set length of stay trimpoints. The costs of any days beyond these trimpoints are excluded to provide a like-for-like comparison of activity and costs. The RCI was also adjusted by the market forces factor (MFF) in order to take account of some areas of the country with higher costs for staff, land or buildings.

Earlier studies have shown that intentions of staff to quit is negatively related to job satisfaction (e.g., [31]). In line with this finding, in our sample we find a negative correlation between job satisfaction and intention to leave. The correlation between the two variables is equal to —0.66. Higher levels of job dissatisfaction raise concerns on the level of effort exerted by staff professionals and hence on the provided quality of care. Moreover, high staff turnover may lead to over-reliance on temporary and agency staff in hospitals and, as such, is one of the “organizational health” indicators used by the regulator as a signal of possible governance concerns. Consistent with this interpretation, and following previous work that has linked higher staff intentions to leave to poorer quality of management (e.g., [32]), in our study we consider lower intentions of staff to quit as an indicator of better hospital performance.

There are indeed examples of FTs introducing novel treatment paths and service arrangements [37 39], although it is difficult to know whether the hospitals would have been able to make such changes anyway without FT status.