such a move would allow for a more integrated national system for ownership and management of hospital estates the nhs could strengthen monitoring and evaluation of provider activities selectively contracting with betterperforming providers to drive quality improvement in the same vein the nhs could look to contract more often with independent providers on clear costquality criteria with expected outcomes specified in contracts selective purchasing could be applied also by the private voluntary health insurance schemes by focusing not only the cost but also the quality aspects of health care alongside these efforts public reporting of provider assessment should also be developed as such information could be used to promote user choice of provider such a plan should consider training needs based on expected retirement rates