Accounting for reform: Funding and transformation in the four nation’s hospital services

The NHS Plan revealed New Labour’s objective to increase funding in the four nation’s hospital services in England, Northern Ireland, Scotland and Wales. Although each country has installed its own institutional arrangements, organisation structures and funding models for the provision of hospital resources and services there are a series of common objectives. These were to increase funding to reduce uncertainty and couple additional funding with reform(s) that would boost capacity to treat patients. In this paper, we reveal that additional hospital funding has not delivered robust financials in the four nation’s hospital sector and that physical transformation is limited and fragile. Our argument is that the logic(s) shaping the policy prescription for the NHS and outlined in the NHS Plan failed to take into account the activity characteristics governing hospital healthcare. Hospital healthcare is delivered in a complex financial, physical, clinical and demographic matrix where the connection between policy and intended outcomes are not straightforward.