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.
Sue
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