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Evidence for greater competition in the NHS ‘flawed’

Research indicating that competition in the NHS had raised quality and saved lives is ‘flawed', a University of London report has claimed.

It comes as the controversial Health and Social Care Bill, which introduces more competition into the NHS, goes to the House of Lords where it faces stiff opposition from Labour, crossbench and some Liberal Democrat peers.

Writing in The Lancet, Professor Allyson Pollock of the Centre for Primary Care and Public Health, Queen Mary College, says that it is wrong to argue for the changes being introduced in the Health and Social Care Bill on the basis of a working paper by health economist Dr Zack Cooper and colleagues.

The London School of Economics paper has been cited by prime minister David Cameron to justify introducing more opportunities for the private sector in the NHS when he announced the legislative pause for the health bill.

Mr Cameron said: ‘Put simply: competition is one way we can make things work better for patients. This isn't ideological theory. A study published by the London School of Economics found hospitals in areas with more choice had lower death rates.'

Professor Pollock said: ‘The study to which Cameron referred was a working paper by Zack Cooper and colleagues. However, contrary to Cooper and colleagues' claims, their study did not show a causal inverse relation between patient choice and death rates.'

She says that the Dr Cooper and colleagues' study does not meet scientific standards.

She said: ‘In the absence of evidence proving that competition improves health, Cooper and colleagues' work should not be cited as scientific evidence in support of choice, competition, or the current market-oriented Health and Social Care Bill 2011,'

Professor Pollock adds: ‘ A revised version of the study, published in The Economic Journal, clarified points of detail, but Cooper and colleagues did not address its fundamental flaws with respect to representation of literature, study design, methods, analysis, data, and conclusions.'