Do We Have a Redundant Set of Cost-Efficiency Targets in the NHS?

There has been a long history of hospital trust cost-efficiency targets being used in the National Health Service (NHS), but there is little evidence about whether they are effective in reducing hospital unit costs and reducing the dispersion of unit costs between trusts. In 1997, the new Labour government announced that it would replace the purchaser efficiency index with a new approach to securing cost-efficiency gains from trusts. Since 1999/2000 trust efficiency targets have been based on reference costs. This article presents evidence to suggest that efficiency targets have not been effective and that the new reference cost based system of targets is irrelevant. The efficiency gains that trusts seek to achieve are those that emerge from the purchaser funding formula and the contracting process.