NEWS
P Closed-shop ‘NHS family’ freezes out other
atients are being denied potentially better, more timely
treatment because of an NHS culture that demands loyalty to the family of NHS hospital providers, according to a new report.
Refusing Treatment by independent think tank Civitas concludes that existing NHS providers use their muscle and connections to keep providing services even when faster, higher quality care is on offer elsewhere.
The results are that the benefits of a decentralised and innovative NHS are being denied to patients who have to wait longer for treatment and fail to access the most appropriate services.
The report, which is based on a one-year study into the relationships between acute trusts and their commissioners, found evidence that surgeons 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.
One medically qualified executive commented: “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.”
Sep/Oct 10
culture of supporting local NHS providers, often regardless of the quality of other organisations: NHS, voluntary or private.
One private provider executive revealed: “I know for a fact that a surgeon in an unnamed NHS trust takes two and a half hours to do a hip replacement that he does in 45 minutes at [one of our hospitals].”
‘NHS family’ nurtures closed- shop mentality
The study suggests that loyalty to the ‘NHS family’ too often has a stronger impact on organisational decision-making than the needs of patients do. As one NHS provider executive explained:
“[There is] a fundamental problem in current market policy: the DH [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 health care for the public and where that health care is delivered should not matter.”
Instead, there remains a
One private provider executive explained how, despite patients being seen an average of 1.2 times before being given a diagnosis at his organisation compared to the local NHS average of 2.8 times (producing a 24 per cent cost saving) (p.35), “the [NHS] acute providers immediately formed a cartel and refused to let their consultants work at the clinic.”
Another participant described how: “NHS doctors ignored the private healthcare clinic staff at local meetings, barred them from training courses, and made it extremely difficult for them to integrate into the medical community, which may have an adverse effect on quality of care. Some NHS physicians walk out of the room when they enter.”
Summing up the situation, one DH official said the market has been blocked “by most people in most places.”
NHS trusts keep the heat on PCTs
NHS trust and foundation trust hospitals have used the guise of ‘defending the NHS’ to bully PCTs into preserving the status quo when better options were available. This has often happened with the support of local politicians and media.
One executive reported: “PCTs are scared of the providers’ political power. They are afraid of putting services out to tender and angering the hospital providers. They are afraid that the hospitals will then go and do
healthcare options to leave patients waiting
something to retaliate that will cause the PCT managers to lose their jobs.”
Hospitals were also found to have engaged in predatory pricing 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.
This practice prevents fair comparisons between healthcare providers, short-changing patients who may then end up with a lower quality, more costly, service.
Co-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.”
Lord Warner, a former Labour health minister, 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.
nhe 7
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92