Do hospitals respond to greater autonomy? Evidence from the English NHS

Foundation Trusts (FTs) were introduced in the English NHS in 2004/5 and gave NHS Trusts the opportunity to become independent not-for-profit public benefit corporations. Whilst remaining in the public sector, FTs were granted greater autonomy than non-FTs. The reform was intended to create incentives for providers to deliver higher quality services in the most efficient way. This paper examines the impact of the FT policy on hospital performance, as proxied by measures of financial management, quality of care and staff satisfaction. Results suggest that generally FTs perform better than non-FTs. However, these differences appear to be long-standing rather than the effect of the FT policy per se and we find some evidence of a convergence in hospital performance between FTs and non-FTs.