In 1993 the system was reformed to create four Regional Health Authorities (RHAs) which were organisations designed to undertake the planning work of the AHBs and to purchase services. Public hospitals were transformed to become Crown Health Enterprises (CHEs) which were expected to turn a profit. The system was based around creating quasi-markets, including separation between purchaser and providers. However, this did not work as efficiently as expected, where contract negotiation was slow, waiting lists grew, as well as the presence of increasing concerns about patient safety issues (Gauld 2003; Devlin, Maynard, and Mays 2001; Ashton 1999, 2002).