Increased competition within NHS has not harmed patients, research finds

An increase in competition in the NHS under Labour has not harmed patients, research has found.

Researchers found no substantial change in socio-economic patterns of hospital use

Researchers from the University of York’s Centre for Health Economics studied the effect of pro-competition reforms introduced in the 2000s by the Labour government on local communities.

Critics of the reforms had warned that increased competition would lead to hospitals ‘cherry-picking’ the most profitable patients.

Researchers used data on all NHS hospital patients in England to examine whether increased competition led to increased socio-economic inequality of access to health care.

From 2001/2 to 2008/9 researchers found no substantial change in socio-economic patterns of hospital use, either overall or for a basket of common hospital services including hip, cataract, heart and gastroscopy procedures.

Project lead Dr Richard Cookson said: ‘Our findings echo similar results from previous research into the Conservative ‘internal market’ reforms of the NHS in the 1990s… Neither Conservative nor Labour attempts to introduce competition into the NHS appear to have had any measurable effect on socio-economic equity in healthcare.’

However Professor Gwyn Bevan and Matthew Skellern at the London School of Economics and Political Science have argued that ‘the jury is still out’ on the effects of hospital competition on quality of care within the English NHS.

The researchers reviewed evidence from three recent econometric studies of the New Labour market, which all show a seemingly causal relation between greater competition and lower hospital mortality.

These studies contradicted previous findings that competition in the NHS was largely ineffective, or even had negative consequences.

The authors said that although the studies were ‘serious and rigorous’ they questioned their use of hospital mortality rates (HMRs) to judge the impact of competition on the quality of elective surgery.

Researchers argued that deaths following elective surgery are so rare that another measure is needed to assess its quality. 

The authors also looked at two econometric studies examining the effects of introducing patient choice in elective surgery which assumed that this competition would improve elective surgery, which would require improvements in hospital quality.

The authors said: ‘We believe there are strong grounds for introducing patient choice into the NHS as an end in itself, given its potential to empower patients and give them greater control over the conditions of their care.’

Nevertheless, they add, how patient choice has affected outcomes in elective surgery 'remains an open question'.

They concluded: ‘More research is required before conclusions can be drawn about the effect of recent reforms on hospital quality, let alone about the merits of the Mr Lansley’s proposals further to extend competition.’

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