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The Royal College of Psychiatrists Improving the lives of people with mental illness

Competition in the NHS

Friday, 24 February

The recent membership survey clearly demonstrated how concerns about competition are central to the beliefs of four in five respondents that the Health and Social Care Bill is fundamentally flawed. The College’s position is that competition should only be used in the NHS where it can be shown to clearly benefit patients.

With this in mind I have been reviewing what the Department of Health describe as an “emerging evidence base” for increasing competition, looking in particular at the lead sources they have cited in their a new factsheet about Choice and Competition. These two papers (Cooper et al, 2010 and NBER Working Paper 16164) examine the impact of the 2006 reforms which introduced competition between NHS hospitals, and suggest that these reforms did indeed improve outcomes and efficiency.

However, the publication this week of a paper from the LSE Centre for Economic Performance about competition is highly significant, as it goes further by comparing the impact of the 2006 reforms with those introduced in 2008 which introduced further competition from the private sector.

The LSE paper concurs with the earlier research that the 2006 reforms improved NHS hospital performance. However, it found that the subsequent introduction of private sector competition in 2008 diminished performance and left NHS hospitals “with a more costly case mix of patients” (although the authors do stress that it is unclear whether private sector providers were actively avoiding treating more complex patients).

Section 3 of the Bill can reasonably be considered as a significant extension of the 2008 reforms and, despite reassurances from the Department of Health that Monitor will "tackle specific abuses...that demonstrably act against patients’ interests", I’d argue that they should be asked to prove that they can stabilise the negative impact of the 2008 reforms before extensively scaling them up as planned. As things stand I am not satisfied that there is evidence that the Section 3 of the Bill will clearly benefit patients as intended. 

Yesterday morning, I had a very interesting meeting with some of our academic psychiatrists. They are working on an unusually energetic and positive recruitment strategy, within the overall recruitment strategy, to ensure we attract more trainee psychiatrists into academic research.

In the afternoon, I met with Helen Cowie, a Professor at the University of Surrey, who has done most of the key work on cyber bullying. She stressed that while we know this has received a great deal of publicity recently, for the most part cyber bullying is happening to victims who are being bullied in other ways as well, and is leading on to depression and anxiety. Those who perpetrate the bullying are being found also to have mental health problems. Helen has just published an excellent new book, From Birth to Sixteen – Children’s Health, Social, Emotional and Linguistic Development, which I'm sure many of you will find interesting.



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