COMMENT
Senior researcher at think tank Reform, Thomas Cawston, explains why competition, contrary to recent argument, can actually improve the health service.
Reform to demonstrate how competition can be used to benefit the health service, when done properly.
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With competition at the centre of current debate on the Health & Social Care Bill as it edges closer to becoming the law of the land, it seems everyone has an opinion they are determined to share. But how much of our perspective on competition is based on prejudice and how much on facts?
Speaking to NHE just ahead of the Liberal Democrat spring conference, Thomas Cawston, senior researcher at Reform and one of the report’s authors, said the evidence is clear.
Reform, known for its preference for market solutions to public policy problems, researched the consequences of competition in several global case studies (see panel, below) and found that it can push providers to transform and integrate – essential in the face of growing demand and shrinking budgets.
Cawston explained: “Over the past few
new report, ‘Healthy Competition’, has been published by think tank
months there have been a number of people saying competition leads to fragmented systems, disrupts care, creates more expense and more inefficiency and reduces quality. We have said that’s not the case.
“Instead, we’ve seen quality of care improving, particularly in some integrated systems in North America, which are seeing new entrants come in that are actually linking up services that were previously disconnected, and which have applied a pathway of care for patients to improve the quality of care very quickly while also saving money.”
Sharp reactions
Integration is the buzzword of the moment in the NHS, and the suggestion that competition could be the answer to fragmented services is one many find difficult to accept: some are convinced it is the answer to our prayers, and others certain it will lead to chaos.
Cawston believes that healthcare “has to change” if the NHS is going to deliver world-class outcomes with value for the taxpayer, and says this is something that more and more people are starting to realise and accept.
He continued: “There’s a general feeling that this would mean a healthcare system that’s more integrated, less based on
hospital care, much more focused on the community, much more focused on technology.”
To deliver this kind of transformation within the timescales the NHS is faced with, he said: “You need competition. You need new entrants to come in with new forms of vision, put pressure on providers to change themselves, deliver services that patients want and need and that are of value to the taxpayer.”
Cherry picking ‘myths’
Fears about private providers cherry picking easier cases to generate easy income, leaving the NHS to deal with more problematic patients and thus less able to compete, are “quite an old concern”, Cawston acknowledges.
He said: “More and more evidence has come out which suggests that the ISTCs (Independent Sector Treatment Centres) did not cherry pick – the case mix was fairly average. I think it’s a complete distraction because ultimately what do you want? You want a system that provides quality for the patients and value for the taxpayers. That might mean you have some services doing some things in different ways, more of a mix of providers.”
He explained that this case mix was to be expected, as independent providers taking
Case studies taken from Reform’s ‘Healthy Competition’ report. Successful health reforms lead to:
Reduced costs through integration and competition • In
Rhode Island, a private company,
Beacon Health Strategies, has created an integrated care pathway for mental healthcare services, which were previously highly fragmented. In one year the cost of mental healthcare hospitalisations for children was cut by 20%.
• In Massachusetts any willing providers were invited to organise community services for low income elderly patients. Patient-centred care management replaced uncoordinated services reducing the number of nursing home admissions by up to 42%.
Reduced costs through standardisation of clinical practice • In the United States MinuteClinic has developed strict protocols for a range of routine services. This has allowed
20 | national health executive Mar/Apr 12
the clinics to use nurses instead of more expensive doctors, enabling them to provide consultations 30 to 50% cheaper than a visit to a GP.
• The Indian specialist maternity hospital LifeSprings has focused on providing a limited number of procedures and used standardised clinical protocols. Doctors’ productivity is four times higher than non- specialist providers and prices are up to 50% lower than of market rates.
Greater patient safety through service reconfiguration • In Finland, the Pirkanmaa region closed joint replacement departments in five hospitals and concentrated care at one specialist hospital. The new hospital delivered complication rates below 1% compared to an average of up to 12% for general hospitals.
• The NHS in London moved emergency
stroke care from 34 general hospitals to 8 specialist units with dedicated staff. London now has the highest standards of stroke care of any major international city.
Greater patient safety through better data
• Birmingham University Hospitals took the initiative to develop its own IT infrastructure to track medical errors and provide decision support to front line clinicians. Medication errors were cut by 66% and contributed to a 17% drop in 30-day mortality.
• The Cleveland Clinic in Ohio has published its clinical outcomes and data used by the hospital leaders to manage productivity, benchmark clinicians and improve quality. The hospital is one of the highest ranked in the United States for quality but costs are half those of equivalent providers.
Copyright Reform Research Trust
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