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NHS a ‘closed shop’ says report

Patients are being denied potentially better, more timely treatment because of an NHS culture that demands loyalty to the family of NHS hospital providers, according to a new report.

Refusing Treatment, by independent think tank Civitas – based on a one-year study into the relationships between acute trusts and their commissioners – concludes that existing NHS providers use their muscle and connections to keep providing services even when faster, higher quality care is on offer elsewhere.

The results are that the benefits of a decentralised and innovative NHS are being denied to patients who have to wait longer for treatment and fail to access the most appropriate services.

The report found evidence that surgeons working in both NHS hospitals and independently run centres often work more effectively in the latter, delivering a more reliable and punctual service to patients. But inertia in NHS providers, where surgeons can play the ‘clinical’ and ‘NHS family’ cards, keeps better working practices from spreading.

The study suggests that loyalty to the ‘NHS family’ too often has a stronger impact on organisational decision-making than the needs of patients do. As one NHS provider executive explained:

[There is] a fundamental problem in current market policy: the DH promotes competition and devotes substantial resources to its implementation, yet it also advocates the cultural sanctity and historic importance of the NHS… I do not believe many people have bought into the idea that the NHS is the organisation that procures health care for the public and where that health care is delivered should not matter.’

Instead, there remains a culture of supporting local NHS providers, often regardless of the quality of other organisations: NHS, voluntary or private. One private provider executive explained how, despite patients being seen an average of 1.2 times before being given a diagnosis at his organisation compared to the local NHS average of 2.8 times (producing a 24 per cent cost saving) (p.35), ‘the [NHS] acute providers immediately formed a cartel and refused to let their consultants work at the clinic’.

Another participant said: ‘NHS doctors ignored the private healthcare clinic staff at local meetings, barred them from training courses, and made it extremely difficult for them to integrate into the medical community, which may have an adverse effect on quality of care. Some NHS physicians walk out of the room when they enter.’

NHS trust and foundation trust hospitals have used the guise of ‘defending the NHS’ to bully PCTs into preserving the status quo when better options were available. This has often happened with the support of local politicians and media. One executive reported:

‘PCTs are scared of the providers’ political power. They are afraid of putting services out to tender and angering the hospital providers. They are afraid that the hospitals will then go and do something to retaliate that will cause the PCT managers to lose their jobs.’

Hospitals were also found to have engaged in predatory pricing by shifting their overheads around to remove costs from services where they want to win competitive contracts, offsetting them onto other services where there was no competition. This practice prevents fair comparisons between healthcare providers, short-changing patients who may then end up with a lower quality, more costly, service.

Co-author James Gubb said:

‘The Coalition Government has put a lot of faith in the power of the market to meet the NHS’s unnerving productivity challenge. The problem is the Coalition isn’t addressing the real issues as to why the market currently isn’t delivering: the overwhelming power of hospitals and the closed-shop “we can do it alone because we’re the NHS” attitude so prevalent across the organisation.’

Commenting on the report, Lord Warner, a former Labour health minister, said:

‘As the interviews in this report reflect, too many NHS personnel are too comfortable or frightened to create the discomfort and public angst that a properly functioning market would bring.’

The existing evidence that secondary care competition can bring the intended benefits in the NHS will be an important guide for future policy as the NHS embarks on major reforms over the coming years.