Bitter Medicine – Reforming the NHS

The Economist 19th April 2014 says: Competition is not the cause of the NHS’s problems The Health Services are too important to let an article from such an eminent magazine pass without comment, and I beg forgiveness for printing it in its entirity. There is no mention of rationing and NHSreality believes that whether there is choice and/or competition is of no relevance to the bigger issue.

LIKE patients shrinking from needles, many doctors fear politicians pushing market-oriented health policies. For more than two decades governments of all shades have injected small doses of competition into England’s publicly funded health system. Reforms passed by the coalition government in 2012 provided the most recent jab. They have left many people feeling queasy.

David Cameron, the prime minister, had hoped to see nearly all of the NHS’s contracts awarded through competitive bidding. In the end, his new rules acknowledged that non-competitive contracting is sometimes the best choice if the process is transparent, unbiased, and clearly benefits patients. But the local groups responsible for purchasing care (known as Clinical Commissioning Groups, or CCGs) complain that they have received mixed messages. Some of the doctors that run CCGs say they fear legal challenges from health providers if they do not tender all of their contracts competitively. In February Andy Burnham, the shadow health secretary, said CCGs had spent £5m ($8.4m) on competition lawyers during the previous year. Sir David Nicholson, former head of the NHS, said that the service is “bogged down in a morass of competition law”.

The health regulator, Monitor, tacitly concedes that the rules could be clearer. It is busy tutoring CCGs on what they actually mean. If they honour common sense and put patients’ interests first “they’re 95% there”, says Andrew Taylor, former head of the NHS’s Co-operation and Competition panel.

And CCGs are probably wrong to believe that the coalition’s most recent reforms will mean their decisions get challenged more often through the courts. In truth, health providers have been growing more combative for years. In 2011 the Royal Brompton hospital in London went to court in the hope of reversing a plan to consolidate paediatric heart surgery in other hospitals. (It lost, but the case had a “signalling effect”, says Mr Taylor.) In fact by beefing up Monitor’s role, the government’s reforms have provided a means of resolving disputes outside the courts.

The reforms will probably have a bigger effect on hospital mergers. The government made it clear that the Competition Act—which prohibits anti-competitive agreements and the abuse of a dominant market position—should be applied to the NHS. In October two cash-strapped hospitals in Dorset were blocked from joining up on the grounds that it would give patients too few choices. This was controversial because the hospitals argued that their agreement would result in better care, a difficult thing to gauge. Some doubt the competition authorities can get the cost-benefit analysis right.

David Bennett of Monitor believes some of the hand-wringers are more interested in ending, not improving, the current competition regime. Mr Burnham admits as much, but his options are limited even if Labour wins the next election. His proposal to favour NHS hospitals and clinics for contracts may turn out to be illegal under European law.

The NHS’s new boss, Simon Stevens, seems keen on competition. Patients will benefit if he can convince critics of its merits. Two studies at English hospitals found that competition saved lives without increasing costs. Another study showed that family doctors located close to rival practices performed better. The medicine is working. Time to increase the dosage.

This entry was posted in A Personal View, Commissioning, NHS managers, Post Code Lottery, Professionals, Rationing, Stories in the Media, Trust Board Directors on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

2 thoughts on “Bitter Medicine – Reforming the NHS

  1. Pingback: Mid Staffordshire NHS trust fined for ‘avoidable and tragic death’ – we may all need an advocate.. | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  2. Pingback: NHS ‘facing funding gap of up to £2bn’ in England | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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