The report (PDF format, 222K), published by independent charitable foundation The King's Fund is based on case studies of 10 NHS trusts and interviews with NHS staff, employers and union officials, conducted between March and May 2007. It is therefore intended to provide insights into the impact of Agenda for Change since its implementation in December 2004, rather than a comprehensive analysis.

Nonetheless, the findings are striking. James Buchan, author of the report, argues that unless NHS managers take steps to ensure that Agenda for Change is properly embedded, its intended aims of of reforming pay, developing new ways of working and delivering better care will never be realised. According to Buchan:

Implementation has been rushed with no one body taking responsibility for ensuring all proposed benefits actually become a reality. As things stand, the ability to deliver all the potential benefits to patients is constrained by variations in local management capacity and willingness for following through with the reform’s original objectives. It will require additional effort and support to realise all the benefits envisaged when the new system was designed and agreed.

• For more on Agenda for Change, see Public sector pay review bodies: most increases staged and Public sector pay 2006/07 (subscription required).