THE LANCET PUBLIC HEALTH: Privatization of NHS ser

Reviewed by partners / Observational study / People

  • The first comprehensive analysis of the effects of the Health and Welfare Act 2012 – which encouraged greater outsourcing of NHS services – suggests that increased privatization has led to a deterioration in the quality of patient care.
  • The outsourcing of NHS services in England to non-profit companies steadily increased between 2013 and 2020, rising to over 6% of the total cost of regional health councils – groups of GPs, nurses and other health professionals who assign services for your local area.
  • Increased privatization is associated with higher levels of treatable mortality, with changes in outsourcing potentially linked to an additional 557 deaths that could have been avoided in England during the study period.
  • The findings suggest caution about further outsourcing NHS services in the future, given the potential impact on the quality of patient care.

The outsourcing of services from the NHS to the private sector is associated with reduced quality of patient care and an increased death rate from treatable causes, according to an analysis published in The Lancet Public Health diary.

The study’s findings show that increased privatization of health services in the UK between 2013 and 2020 is linked to higher levels of treatable mortality – deaths that are thought to have been avoided with timely, effective healthcare – which shows a decline in quality. of health care during the period.

The study is the first comprehensive assessment of the privatization of health services in England since the introduction of reforms in 2012 to encourage more outsourcing. The influence of the Health and Social Care Act on the quality of health care is disputed. Since its introduction, there have been deteriorating trends in some health quality indicators, including treatable mortality rates. [1] However, the lack of data suitable for analysis meant that so far no studies have examined the links between outsourcing at the level of regional health councils and health outcomes.

“The unprecedented data used in this study allowed us to conduct the first rigorous analysis of one of the most controversial health care reforms in recent English history. While some argue that the Health and Welfare Act will improve the efficiency of health services by increasing competition, our findings add to long-standing fears that it could instead lead to lower costs and poorer health outcomes. says study author Benjamin Gooder of Oxford University [2]

The authors analyzed a new data set showing how much each regional health council spent on outsourcing between 2013 and 2020. Changes in the quality of health services were identified using a statistical analysis to examine the links between outsourcing and treatable mortality, a key performance indicator of timely health interventions [3]. Further analysis looked for some link between outsourcing and preventable mortality – deaths that can be avoided mainly through effective public health rather than medical interventions – which is not considered a measure of health care quality.

The data contains more than 12,700 files containing details of outsourcing costs from regional health council websites. This resulted in figures of over £ 204 billion in expenditure – consisting of more than 645,000 individual payments – for 173 of England’s 191 (as of 2019) Regional Health Councils between April 2013 and February 2020. [4].

The analysis suggests that overall levels of outsourcing in England have been rising steadily since 2013, rising from less than 4% to more than 6% of the Regional Health Council’s total expenditure by 2020. A total of £ 11.5 billion were spent on outsourcing of health services to the private sector during the period, the amount varying significantly depending on the individual health council. The largest increase in outsourcing costs was for business and IT support, with a steady increase in costs for health enterprises, social activities and transport companies.

Statistical analysis showed that an annual increase in outsourcing costs of 1% was associated with an increase in treatable mortality of 0.38% (0.29 deaths per 100,000 population) next year. Based on the observed changes in outsourcing costs and treatable deaths for each health council, the analysis shows that 557 additional deaths between 2014 and 2020 can be attributed to changes in outsourcing.

There is no link between outsourcing and preventable mortality rates. This further suggests that the link between outsourcing and treatable deaths is related to the quality of care and not a consequence of general trends in health outcomes among the population.

The study’s author, Dr. Aaron Reeves of Oxford University, said: “These results clearly have an impact on the NHS privatization debate, suggesting that increased outsourcing to the private sector may lead to a decline in the quality of care provided to the private sector. patients. Although more research is needed to determine the exact causes of deteriorating health care in England, our findings suggest that further increasing NHS privatization would be a mistake.

“The findings of this study are timely, as the way health councils are organized in England will be reworked. This creates a key point in which the role of the private sector within the NHS must be closely monitored. ” [2]

The authors acknowledge some limitations of their study. Major changes in regional health councils since 2013 have limited the ability to accurately measure outsourcing before or to perform pre- and post-analysis. The results are not evidence of a causal link between outsourcing and mortality, so it cannot be ruled out that other factors may be included. The outsourcing files do not contain details of specific services provided by providers, which means that more research is needed to determine whether certain services are the main cause of the observed trends.

Writing in a related commentary, Professor Andrew Street of the London School of Economics and Political Science, who did not take part in the study, said: dominated by the National Health Service (NHS). Despite the impossibility of establishing a causal mechanism, the study complements the evidence base examining the impact of privatization on the health care system in England.

Regarding the prospect of further privatization in the English healthcare system, Professor Street says: “Profitable providers can make more profit for their shareholders by being innovative and quickly adopting the latest technologies. But a faster path to profit can be a compromise with quality.

The only protection against this double-edged sword is through the contract: quality standards must be fully spelled out, there must be careful monitoring of performance and there must be strict application when standards are not met.

Link to the publication of the embargo: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00133-5/fulltext

[1] Quote directly from the author and can not be found in the text of the article.
[2] Quote directly from the author and can not be found in the text of the article.
[3]https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulletins/avoidablemortalityinenglandandwales/2019
[4] https://osf.io/preprints/socarxiv/t4x52/

The labels were added to this press release as part of a project led by the Academy of Medical Sciences aimed at improving the transmission of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf, if you have any questions or feedback, please , contact the Lancet Press Center [email protected]


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