Market forces within the National Health Service have failed to deliver on the promise of boosting the quality and efficiency of care, claims a new report by independent social think tank Civitas.
Its review of evidence following Labour’s 2002 renovation of NHS policy has concluded that, while market-based reforms have contributed to certain improvements, such as reduced waiting times and better access to health services, these benefits are not widespread.
In fact, Civitas’ report, The impact of the NHS market: An overview of the literature, argues that the wider introduction of market forces to the health service has nurtured a climate where innovation is “meagre”, providers remain all-powerful and commissioners weak, and collaboration – at both a professional and organisational level – is undermined.
The report slams many of Labour’s market-driving initiatives affecting both the demand and supply arms of health care. For example, with regard to the hot potato that is GP practice-based commissioning, it claims commissioners are “more interested in self-provision than commissioning new services”, that the level of support from primary care trusts varies significantly, and that governance remains poor.
In terms of PCT commissioning, it says trusts lack effective purchasing skills and that evidence of poor local management of resources was found. Furthermore, PCTs often fail to utilise their power when purchasing services, too frequenlty giving suppliers the upper hand, the report stressed.
On a different note, while patient choice – another of the government’s flagship policies based on using a competitive element to drive improvement – has indeed helped to slash patient waiting times, the report notes that uptake of choice is not widespread and the quality of information on providers is “weak”, and that its effect on healthcare equality is yet to be determined.
“Market-based reform in the NHS promised great things, but, as things stand, it has yet to bring about the benefits we see from markets in other industries in any comprehensive form: increased responsiveness to customers; better quality; improved efficiency; and innovation,” said report author Laura Brereton. “The NHS appears to be in the unfortunate position of taking on the extra costs of competition without realising the benefits”, she concluded.
The British Medical Association will likely welcome the report’s findings given that it has long argued against commercialisation of the NHS, and is running a campaign highlight the short-comings of market-driven reforms which, it claims, are not only wasting public money but are also having a negative impact on local health services.
According to the BMA, turning to the private sector for funding for new hospitals has “resulted in crippling debts for NHS Trusts”, and the introduction of competition between healthcare providers, as well as “costly deals” for independent sector treatment centres, has hit many existing services.
