The privatization of NHS care accelerated by conservative policies a decade ago has been matched by a decline in quality and “significantly increased” deaths from treatable causes, says the first such study.
The highly controversial health service reform in England in 2012 by Health Secretary Andrew Lansley in the Tory-Lib Dem coalition government forced local health agencies to tender for service contracts.
Since then, billions of pounds of taxpayer cash have been handed over to private companies to treat NHS patients, according to the historical review.
It shows that the growth of health contracts tendered to private companies has been associated with a decline in the quality of care and higher rates of treatable mortality: deaths of patients considered preventable with timely and effective health care.
The Oxford University analysis has been published in the journal Lancet Public Health. “The privatization of the NHS in England, by outsourcing services to for-profit companies, has steadily increased [after 2012]”he says.
“Private sector outsourcing corresponded to a significant increase in treatable mortality rates, potentially as a result of a decline in the quality of health services.”
With a record 6.5 million patients waiting for care, and private companies lined up to help cope with the delay exacerbated by the Covid-19 pandemic, research will generate new fears about potential damage of the increased outsourcing of NHS care.
“Our study suggests increased for-profit outsourcing of clinical order groups [CCGs] in England it could have negatively affected the quality of care provided to patients and led to an increase in mortality rates, ”the authors said.
“Our findings suggest that further privatization of the NHS could lead to worse health outcomes for the population.”
Graph: deaths from treatable causes over time
The study examined the impact of the Health and Social Care Act 2012 in England, which “intensified pressure on the NHS to outsource the provision of state-to-state services to private for-profit providers”.
The researchers analyzed data showing how much they spent 173 CCGs in England outsourcing between 2013 and 2020, which grew from 3.9% to more than 6.4%. In all, £ 11.5 billion was delivered to private companies during the period, although the amount varied considerably between GCC.
The analysis shows that an annual increase in outsourcing expenditure of 1% is associated with an increase in treatable mortality of 0.38%, or 0.29 deaths per 100,000 people, the following year. Researchers say an additional 557 deaths between 2014 and 2020 could be attributed to increased outsourcing.
The authors speculated that the higher mortality could be due to private companies “providing poorer quality care, causing more health complications and deaths,” or because increased competition for contracts could result in suppliers with the intent to profit prioritize shorter waiting times “at the expense of”. of quality care ”.
“While some have argued that the Health and Welfare Act would improve the performance of health services by increasing competition, our findings add merit to long-term concerns that could lead to lower costs and poorer health outcomes. said study leader Benjamin Goodair. of Oxford University.
Dr David Wrigley, vice-president of the British Medical Association, said the doctors’ union had repeatedly raised concerns that ministers would throw “large sums of money at private companies instead of investing in rebuilding our system”. health and care “.
“An outsourcing policy with minimal oversight, governance or transparency is one that will lead to reduced quality and poorer patient care, which is exactly what today’s Lancet study shows,” he said.
The waiting list for NHS care in England this month reached 6.5 million. Dr Danny Bhagwati, vice president of the Medical Association, said: “Given the scale of the backlog and the proposed solutions involving the use of the private sector, these data highlight the risk for patient safety must make the government study the regulation of this sector urgently ”.
A subsequent analysis looked for any association between outsourcing and preventable mortality: preventable deaths with effective public health rather than medical interventions.
None were found, suggesting that the relationship between NHS procurement and treatable deaths is related to the quality of care, rather than as a result of general trends in health outcomes. the population.
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“We have sounded the alarm for years about the false promotion of outsourcing as better for healthcare and better for the NHS,” said Alan Taman, a spokesman for the Doctors for the NHS campaign organization. “That vindicates what we’ve been saying.”
The authors acknowledged several limitations to their research. Their findings are not evidence of a causal relationship between outsourcing and deaths, so other factors cannot be ruled out.
Nigel Edwards, executive director of Nuffield Trust, warned that the study “leaves many questions unanswered, especially if outsourcing is directly responsible for these results or simply associated with them”.
However, the co-author of the study, Dr Aaron Reeves, of Oxford University, said: “These findings clearly have implications for the NHS privatization debate, suggesting that increased outsourcing in the private sector could lead to a decrease in the quality of care provided to patients.
“While further research is needed to determine the precise causes of the declining quality of healthcare in England, our results suggest that a further increase in NHS privatization would be a mistake.”
When the NHS outsourcing has had problems
Hospitals
In 2012, Circle became the first for-profit healthcare company to take charge of an NHS hospital when it took over Hinchingbrooke Hospital in Cambridgeshire. However, he returned the contract to the NHS in 2015 after the hospital experienced financial problems and could not keep up with the rising demand for care, which the Healthcare Quality Commission described as ” insufficient “.
Eye care
Vanguard faced legal action for a series of eye surgeries performed in 2014 at Somerset’s Musgrove Park Hospital. A confidential Vanguard report said the operations appeared rushed and surgeons could continue to practice even after patients reported serious complications. The hospital terminated his contract with Vanguard after just four days.
Mental health
Major private mental health hospital chains treating NHS patients have been criticized dozens of times by forensics and investigative juries over the past decade for providing unsafe care. The Priory, Cygnet, and Elysium have been censored at least 37 times for errors and shortcomings in care related to the death of patients, including several children.