Reforms costing £1 billion and designed to make the National Health Service more efficient and patient-friendly have failed to have much impact, two leading audit bodies have concluded in a report.

The aim of the reforms was to introduce market disciplines into the NHS. They include giving patients choice in where they are treated (including independent-sector treatment centres — ISTCs), paying hospitals only for the treatments they deliver, setting up foundation trusts, and encouraging GPs to become involved in planning how care should be provided.

But so far, conclude the Audit Commission and the Healthcare Commission, sticks have proved more effective than carrots in motivating change.

NHS services have got better but largely as a result of central targets and more money — the traditional tools of NHS management. The “marketisation” initiative, introduced piecemeal over the past five years, could still work but has yet to contribute much.

Doctors and opponents of the reform agenda introduced under Tony Blair will rejoice at these findings. But the report is not saying that they were a bad idea, or that they have failed. It concludes more modestly that they have taken longer than expected to take effect and have still to prove themselves.

On the positive side, the reforms have brought better financial management and a more businesslike approach. Competition for patients by ISTCs has led some NHS hospital to raise their game.

But it is more the fear that patients will choose to take their business elsewhere rather than the actuality that has driven change. Surveys show that less than half of patients — 44 per cent, at the last count — are actually offered a choice of hospitals by their GPs.

And ISTCs have carried out only a tiny fraction of operations, many fewer than they were contracted to do. GPs have largely chosen to boycott ISTCs, and have been lukewarm about Patient Choice.

In 2006-07, only 11 per cent of primary care trusts were using the Choose and Book system for booking appointments despite a goal of 90 per cent utilisation. Such evidence suggests “that the challenge of persuading GPs to adopt the new system has been greater than anticipated,” the report said.

Michael O'Higgins, the chairman of the Audit Commission, said: “This has been a quite massive reform programme. Has it delivered? It has certainly made changes to the NHS, but have they affected patients? Not yet.

“It should deliver over the next few years, but there is an element of wait and see. The direction of travel is good, but the results so far are only fair.

“We don't underestimate the scale of the challenge of reforming the NHS. It employs four times more people than Tesco and is a much more complex organisation, so it will take time to deliver such major changes.

“But given the massive investment in the NHS in recent years, taxpayers and patients rightly expect that their money is spent as efficiently as possible and that services are improving. The NHS must keep the pressure on to make these reforms work for patients.”

Sir Ian Kennedy, the chairman of the Healthcare Commission, said: “These were ambitious reforms that were never going to be easy to deliver.

“It's clear that there have been advances in important areas and that the building blocks are in place for more significant improvements in the quality of care.

“It's also clear that the reforms have not yet achieved what was promised and that progress is behind what some might have hoped for at this point.

“The vision was never clearly articulated. But there are some excellent examples where care has been improved, and the possibility of future improvements is good.”

The report identifies some looming problems. For example, foundation trusts are expanding services at a time when the Government says that care in the community should be the future trend. The primary care trusts have the power but lack the stomach to rein in the hospitals.

The Government said that, by 2004, consultants who had previously only worked in hospitals would be providing four million outpatient appointments in the community. But no data has been collected to measure this, a situation that needs to be urgently addressed, the study said.

“If this target had been met, there should have been a noticeable decrease in the number of outpatient appointments, or at least a change in the rate of growth,” it said. But the number of outpatient appointments in the past six or so years has remained constant.

Anna Dixon, Director of Policy at the King's Fund, said: “We agree with the report's recommendations that greater effort is needed to improve the quality of commissioning, particularly by engaging GPs better.

“We also agree that much more work is needed to ensure the availability and quality of information about health care services. Without such information about both public and private sector providers it will be impossible to judge whether the NHS reforms as a whole have been a success.

“One area of concern is the large investment in the new contracts for NHS staff which do not appear to have resulted in increased productivity or delivered commensurate benefits for patients.”

Explore Health

• Expert Advice

• Health Features

• Mental Health

• Alternative Medicine

• Child Health

• Health Club