NHS reforms are failing to deliver widespread benefits, research reveals.
A study by think tank Civitas suggests that efforts to establish market forces within the NHS have been compromised by continuing centralised control.
On the plus side, reforms have led to improved access for patients, reduced waiting times and improved financial management. But, it claims the benefits are not widespread with weak commissioning, low levels of innovation, and poor professional and organisational collaboration.
Report author Laura Brereton said: “While there have been improvements, they are not clearly attributable to market based reforms. The NHS appears to be in the unfortunate position of taking on the extra costs of competition without realising the benefits.”
The report says patient choice has contributed to reducing waiting times but the uptake of choice is not widespread. The Choose and Book system on which it relies is restrictive, it says, and the quality of information on providers available to patients is weak.
It claims that the threat of competition has driven efficiency in some places. Quality of care, including patient satisfaction, is often seen to be better in new entrants such as privately run ISTCs. But competition has led to confusion over the relationship between commissioners and providers and made collaboration more difficult.
Foundation trusts have performed well financially and on routine quality measures, it says. But they were the best performing hospitals before their change in status and there is little evidence to suggest they’re more innovative.
Payment by results coincided with an increase in activity and efficiency, improved financial management and a decrease in unit costs. But the report says the setting of the tariff at the ‘average cost’ encourages providers to be average. Hospitals are also incentivised to induce demand inappropriately.
Problems are also highlighted with commissioning, particularly among PCTs which are accused of lacking the necessary skills to drive performance and purchase effectively.
James Gubb, director of the health unit at Civitas, said: “While the NHS is better than it was in 2002, wavering commitment to the idea of a market has unquestionably stymied the impact it could have had.”
Read the full report.