Independent research backs competition in the NHS

Following the passing of the Health and Social Care Bill the Economic and Social Research Council (ESRC) have released their findings relating to competition in the NHS. As an independent research body there should be some weight to their opinions and it is generally positive in relation to competition within the NHS for the following reasons:

• Hospitals located in areas where patients had more choice had greater improvements in clinical quality and greater reductions in lengths of stay post policy than hospitals located in less competitive areas. Additionally, the hospitals in competitive markets increased their quality without increasing total operating costs or shedding staff.
• While around half the acute hospitals in England were involved in a merger between 1997 and 2003, recent studies have shown that these did not make improvements with one possible reason being that mergers reduce the potential for competition in a local market.
• Another study of management in the NHS shows that better management is associated with better outcomes in NHS hospitals and that management tends to be better where hospitals compete with each other.

So while there has been a lot of debate about the future of the NHS and in the extreme the end of the NHS, perhaps we should bear this research in mind as the ESRC conclude:

there is no evidence from recent studies of the UK that allowing patients more choice and exposing poorly performing hospitals to the threat of their patients choosing another provider is going to lead to the whole-scale destruction of the NHS and large equity issues. On the contrary, the evidence we have suggests that it has the power to improve outcomes for patients.

New research: Hospital mergers do not work

There has been a policy of making efficiency savings for a very long time now, particularly in the NHS. As part of this we have had hospital closures and services being moved and hospital mergers arguing that this will bring improvements for patients. Recent research has been published which shows that mergers do not do what they intended to do. Something we should take into consideration when we talk about our health policy and particularly when it comes to local campaigning.

Can governments do it better? Merger mania and hospital outcomes in the English NHS examined the merged hospitals up to four years after the date from which it was agreed and looked at a large range of measures of performance, including staff activity, financial performance, waiting times and data collected by the department to assess the performance of trusts.

The researchers’ findings (reported here in the Guardian) showed that hospitals that merged recorded larger deficits after merger than before, and the length of time patients had to wait for elective treatment also rose. In addition, there were few indications of improvements in clinical quality and no increase in the productivity of staff. While hospital admissions fell by about 10% four years after hospitals merged, staff numbers fell in proportion. So for each staff member employed, there was no increase in activity.

The Lib Dems have long campaigned on the need for good quality local services and this is as good a message as ever. Large scale reorganisation does not always do what you think it will and mergers have shown that it certainly does not improve services for patients. I don’t know how many times it takes to learn what we already know. When it comes to public services, it is how the service is delivered on the ground that matters most. Good managers, with good staff, provide a good service.