Hospital Dr News

NHS “protectionism” excluding private providers

The NHS has a protectionist mentality which prevents private health providers from offering better services, a report claims.

The provocative report by the think tank Civitas says some patients are missing out on better services because of commissioners’ loyalty to NHS hospital providers.

The one-year study into the relationships between acute trusts and their commissioners concludes that existing NHS providers use their muscle and connections to keep providing services even when faster, higher quality care is on offer elsewhere.

Refusing Treatment quotes one anonymous NHS provider executive as saying: “There is a fundamental problem in current market policy: the Department of Health promotes competition and devotes substantial resources to its implementation, yet it also advocates the cultural sanctity and historic importance of the NHS…I do not believe many people have bought into the idea that the NHS is the organisation that procures healthcare for the public and where that healthcare is delivered should not matter.”

Instead, the report claims there remains a culture of supporting local NHS providers, often regardless of the quality of other organisations.

It also suggests surgeons are complicit in maintaining the NHS’s pre-eminence, claiming that those working in both NHS hospitals and independently run centres often work more effectively in the latter, delivering a more reliable and punctual service to patients. But inertia in NHS providers, where surgeons can play the ‘clinical’ and ‘NHS family’ cards, keeps better working practices from spreading, it claims.

One medically qualified executive is quoted anonymously in the report saying: “It’s a question of having the will. Four surgeons didn’t turn up for work here yesterday, blaming the snow. In the private sector they’d all turn up… In the health service there just isn’t the will to work too hard, because you won’t get fired and you’ve got your pension.”

It quotes another anonymous private provider executive saying: “I know for a fact that a surgeon in an unnamed NHS trust takes 2.5 hours to do a hip replacement that he does in 45 minutes at one of our hospitals.”

NHS hospital trusts have used the guise of ‘defending the NHS’ to bully PCTs into preserving the status quo when better options were available, it says. PCTs are scared of the providers’ political power.

Hospitals have also engaged in predatory pricing, the report claims, by shifting their overheads around to remove costs from services where they want to win competitive contracts, offsetting them onto other services where there was no competition.

Author James Gubb said: “The coalition government has put a lot of faith in the power of the market to meet the NHS’s unnerving productivity challenge. The problem is the coalition isn’t addressing the real issues as to why the market currently isn’t delivering: the overwhelming power of hospitals and the closed-shop ‘we can do it alone because we’re the NHS’ attitude so prevalent across the organisation.”

Former Labour health minister Lord Warner said: “As the interviews in this report reflect, too many NHS personnel are too comfortable or frightened to create the discomfort and public angst that a properly functioning market would bring.

“The existing evidence that secondary care competition can bring the intended benefits in the NHS will be an important guide for future policy as the NHS embarks on major reforms over the coming years.”

Read a blog on competition.

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