Capital investment proposals in the National Health Service are considered on a case-by-case basis and assessed against key approval criteria set down by the department and Treasury. Each proposal is subject to a value-for-money test which compares the risk adjusted, whole-life costs and benefits of a public capital-funded option (known as the public sector comparator) with one provided under the private finance initiative (PFI). PFI involves a private sector consortium raising finance either through a loan from a bank or from the capital markets (bonds).
NHS trusts report key financial information to the department on a monthly basis, and detailed financial information on a quarterly basis. The financial information is signed off locally by the organisation's chief executive and director of finance, and by the strategic health authority cluster chief executive and director of finance.
In addition, the NHS performance framework includes the financial assessment of NHS trusts. This is monitored on throughout the year, and reported on a quarterly basis.
As part of the national patient survey programme, run by the Care Quality Commission, patients are asked about their experience of receiving NHS services. Their responses are used to produce quantitative, comparable data which can be used to benchmark organisations.