Most PFI hospital contracts are well-managed and the evidence indicates that they are currently achieving the value for money expected when the contracts were signed. There continue to be risks, however, to the long-term value for money of these contracts.
“Current services for people who suffer major trauma are not good enough. There is unacceptable variation, which means that if you are unlucky enough to have an accident at night or at the weekend, in many areas you are likely to receive worse quality of care and are more likely to die. The Department of Health and the NHS must get a grip on coordinating services through trauma networks, on costs and on information on major trauma care, if they are to prevent unnecessary deaths.”
“Care for people who have had a stroke has significantly improved since we reported in 2005. The publication and early implementation of the stroke strategy have begun to make a real difference and have helped to put in place the right mechanisms to bring about these improvements. There is still work to be done though: the poorer performers must be dragged up to the same standard as the best, so that the gains that have been made are sustained and value for money improved further. The Department should focus on ensuring that health, social care and employment services are working together much more effectively.”
“The Programme to make social sector housing and private sector housing for vulnerable people decent has made progress, and the families living in those properties will be enjoying the benefits. However, there are risks to both the Programme’s completion and what has been achieved so far if a reliable funding mechanism is not put in place to deliver the remainder of the Programme and to maintain homes to a decent standard. Hundreds of thousands of families are still living in properties which are not warm, weather tight, or in a reasonable state of repair. The Department’s efforts have been undermined by weaknesses in the information it holds.
There are important lessons here on the benefits of having clear information on Programmes when delivery is devolved to a local level.”
“The Department of Health stated in October 2007 that dementia was a national priority and brought forward a widely supported strategy in February 2009 to transform the lives of people with dementia. The action however, has not so far matched the rhetoric in terms of urgency. At the moment this strategy lacks the mechanisms needed to bring about large scale improvements and without these mechanisms it is unlikely that the intended and much needed transformation of services will be delivered within the strategy’s five year timeframe”
“The coalfields regeneration programme has achieved positive results in job generation and improved environments. However, the programme has taken much longer than expected to deliver results and needs to be much better planned. What we want to see is a concerted effort to deliver to the coalfields the best possible value for money from the remaining £450 million of funds.”
“To have a significant impact on chlamydia requires overall testing levels of 26 per cent or above. Only half of Primary Care Trusts reached this level in 2008-09, six years after the Programme’s launch. Combined with the local inefficiencies and duplications, this shows that the delivery of the Programme to date has not demonstrated value for money.”
“Patients with this debilitating and distressing disease are not identified or treated quickly enough and this dramatically affects long-term outcomes and people’s ability to remain in work. The NHS should take a more co ordinated approach to identifying people with symptoms of early rheumatoid arthritis, so that they get access to specialist care quickly and receive support and advice to help them manage and live with the disease. This would provide better value for money, better outcomes for patients, and lead to productivity gains for the economy. Some of the systemic improvements needed to manage and control this disease also apply to other long-term conditions requiring specialist-led care.”
“It is clear from teachers’ responses that partnering delivers motivational benefits and plays naturally to their style of collaborative working and problem-sharing. With a somewhat more demanding assessment of costs against the benefits achieved, these valuable relationships could deliver significantly more demonstrable benefits than they do now.”
“The Department of Health’s hands on approach to what seemed, in 2004, to be an intractable problem, has been successful in reducing MRSA bloodstream and C. difficile infections. This is a significant achievement and a good example of what concerted effort can achieve. Inevitably, with a focused and centrally driven initiative of this kind, the improvements are not uniform across the NHS and we still don’t know in any meaningful way what impact there has been on other healthcare associated infections. We have identified a number of key problems that need to be addressed such as: a lack of robust comparable data on other infection risks; increases in antibiotic resistance and poor data on hospital prescribing; and that compliance with good practice is still not universal.”