The privatization of NHS care, accelerated by Tory policies a decade ago, corresponds to a deterioration in quality and a “significantly increased” mortality rate from curable causes, according to the first study of its kind.
The highly controversial shake-up of the health service in England in 2012 by Health Minister Andrew Lansley in the government of the Tory-Lib Dem coalition forced local health authorities to tender contracts for services.
Since then, billions of pounds of taxpayer money have been donated to private patient care companies in the NHS, according to the remarkable review.
This shows that the growth of health contracts offered to private companies is associated with a decline in the quality of care and higher levels of treatable mortality – deaths of patients who are considered avoided with timely, effective health care.
The Oxford University analysis was published in the journal Lancet Public Health. “The privatization of NHS in England, through the outsourcing of services to profitable companies, is constantly increasing [after 2012]”he says.
“Private sector outsourcing corresponds to significantly increased levels of treatable mortality, potentially as a result of a decline in the quality of health services.
With a record 6.5 million patients now waiting for care and private companies lined up to help tackle the backlog exacerbated by the Covid-19 pandemic, the study will raise new fears about the potential harms of increased outsourcing. of the NHS.
“Our study shows that outsourcing has increased with profits from clinical groups for commissioning [CCGs] in England, it may have adversely affected the quality of care provided to patients and lead to increased mortality rates, ”the authors said.
“Our findings show that further privatization of the NHS could lead to poorer health outcomes.”
Graphics: deaths from treatable causes over time
The study examines the impact of the Health and Welfare Act 2012 in England, which “increased pressure on the NHS to outsource the provision of services from public providers to private providers.”
Researchers analyzed data showing how much 173 CCGs in England spent on outsourcing between 2013 and 2020, rising from 3.9% to more than 6.4%. A total of £ 11.5 billion was transferred to private companies during the period, although the amount varied considerably between CCGs.
The analysis shows that an annual increase in outsourcing costs of 1% is associated with an increase in treatable mortality of 0.38% – or 0.29 deaths per 100,000 people – next year. Researchers claim that 557 additional deaths between 2014 and 2020 may be due to increased outsourcing.
The authors speculate that higher mortality may be due to private companies “providing lower quality care, leading to more health complications and deaths” or because greater competition for contracts could lead to profitable suppliers give priority to shorter waiting times “at the expense of quality of care”.
“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,” he said. study leader Benjamin Gooder of Oxford University.
Dr David Wrigley, vice-president of the British Medical Association, said the doctors’ union had repeatedly expressed concern about ministers throwing “huge sums of money into private companies instead of investing in rebuilding our health and care system”.
“It is an outsourcing policy with minimal oversight, management or transparency 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 care at the NHS in England this month reached 6.5 million. Dr Dani Bhagwati, Vice-President of the Association of Physicians, said: “Given the scale of the backlog and the proposed solutions involving the use of the private sector, these data, which highlight the risk to patient safety, should lead to this. the government to consider the regulation in this sector urgently. “
Further analysis looked for some link between outsourcing and preventable mortality – deaths that could be avoided with effective public health instead of medical interventions.
None was found, suggesting that the link between NHS service provision and treatable deaths is related to the quality of care and not as a result of general trends in public health outcomes.
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“We have been raising concerns 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 NHS campaign. “That confirms what we’re saying.”
The authors acknowledge several limitations of their study. Their findings are not evidence of a causal link between outsourcing and deaths, so other factors cannot be ruled out.
Nigel Edwards, CEO of Nuffield Trust, warned that the study “leaves many questions unanswered – not least whether outsourcing is directly responsible for these results or simply related to them.”
However, the study’s co-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 could lead to a decline in the quality of care. provided to patients.
“While more research is needed to determine the exact causes of deteriorating health care in England, our findings show that further increasing NHS privatization would be a mistake.
When NHS outsourcing encounters problems
Hospitals
In 2012, Circle became the first profit-oriented healthcare company to head an NHS hospital when it took over Hinchingbrooke Hospital in Cambridgeshire. However, he returned the contract to the NHS in 2015 after the hospital had financial problems and was unable to cope with the growing demand for care, which was declared “inadequate” by the Quality of Care Commission.
Eye care
Vanguard is facing a lawsuit over a series of eye surgeries performed in 2014 at Musgrove Park Hospital in Somerset. A confidential report for Vanguard said the operations seemed hasty and that surgeons were allowed to continue practicing even after patients reported serious complications. The hospital terminated its contract with Vanguard just four days later.
Mental health
Major chains of private mental health hospitals that treat patients at the NHS have been criticized by jurors and jurors dozens of times over the past decade for providing unsafe care. Priory, Cygnet and Elysium have been convicted at least 37 times of errors and omissions in care related to the deaths of patients, including several children.
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