In the late 1990s community health services (CHS) were integrated with commissioners of services in Primary Care Trusts (PCTs). By the mid 2000s, it was decided that CHS should be organisationally separated from commissioners. This was part of a general move towards increasing market structures and competition in the NHS. One potential organisational form for CHS was the creation of community NHS Foundation Trusts (CFTs). In 2007, the Department of Health (DH) set up a pilot programme to establish a number of CFTs by 2009. In 2008, the DH commissioned this study, to evaluate the CFT pilot programme.

The aim of the summative evaluation was to identify the outcomes of the DH pilot programme establishing CFTs. The evaluation aimed to focus on whether participants in the pilot programme, in comparison with in-house providers of CHS, delivered:

1. an increased rate of service quality improvement
2. improved value for money

The aim of the formative evaluation of the processes of change was to identify the drivers of change, and the causes lying behind any observed quality improvements. This qualitative part of the evaluation would distinguish the key success factors which could subsequently be used to improve CFT policy as it was rolled out nationally.
Specific issues to be addressed would include:

1. whether decisions were being made differently than before due to increased autonomy of the CFTs;
2. whether the involvement of the staff, patients and the public in CFT governance arrangements had made any difference to performance in terms of management procedures and responsiveness to patients needs; and
3. Whether stronger financial incentives and the changed governance regime had affected how CFTs work in partnership with others, for example GPs, PCTs, and local authorities.

The original study design and methods consisted of the following elements:

Quantitative analysis
Up to 6 CHS within the DH CFT pilot programme would be selected for inclusion in the study. These would then be used to select a matched sample of non-participant CHS. The total sample of 12 autonomous providers and comparator CHS would be treated as a quasi-experiment in which the pilot group participants would form the observation group and the non-pilot group participants would form the control group. The study would use a before-and-after difference-in-difference methodology.

Qualitative study
The qualitative formative evaluation would primarily consist of interviews with key actors. These were mainly managers, information officers and other key informants within the PCTs and CHS provider organisations. The design was that the interviews would focus on a subset of the 12 case study units, perhaps up to four in total.
The project would extend the sample to include at least one social enterprise providing CHS.