Opening up the NHS?

Stethescope "Death rates of patients undergoing major surgery at NHS hospitals are to be published on the internet.


Death rates are expected to be at a disproportionately high level in hospitals where fewer operations are performed and surgeons have less opportunity to improve.

The government believes publishing the figures will mean badly performing trusts will have to improve standards or halt areas of surgery where they are lagging behind."

This, from a report in the Telegraph, is great news.  If patients can make an informed choice then that should put pressure on the acute trusts to up their standards.  In fact, this is long overdue:

An inquiry into the deaths of children at Bristol Royal Infirmary a decade ago showed how poor practice persisted because mortality rates were not disclosed.

The effect will be limited though as - within the NHS - patients only have a limited amount of choice.  While the trusts could compete with each other to a certain extent they are protected from new entrants to the market, a restriction that will severely limit the ability of patients to take advantage of this new information.


Beyond that, the structure of the NHS will restrict the ability of the trusts to respond to quasi-market pressures introduced by this new source of information.  The NHS is essentially a quango of quangos.  It is made up of a combination of the primary and acute trusts, strategic health authorities and a maze of central quangos.  In our report, Wasting Lives: a statistical analysis of NHS performance in European context since 1981 (PDF), we set out how the central quangos control many of the most important NHS decisions:

"The NHS has a large number of local bodies, the Primary Care Trusts, NHS Trusts and Regional Strategic Health Authorities.  However, these are all both legally non-departmental bodies answering to the Department of Health and effectively part of one organisation.  Most have only a very limited ability to act independently:

    • Their decisions over which drugs to buy are expected to conform to guidance from the National Institute for Health and Clinical Excellence.

    • IT expenditure is mostly handled by Connecting for Health which runs the National Programme for IT , the largest single information technology project in the world.

    • Staff pay, the largest item of expenditure,  is determined nationally by the NHS Pay Review Body.

  • Amounts of funding are also set nationally according to a weighted capitation formula.   This became very controversial in 2006 when the Government were accused of manipulating the funding decision for political advantage."

This information will be a valuable resource for NHS patients.  It would be so much more valuable if our healthcare system were liberalised more broadly.

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