Health Management and Policy Alert

Market structure, patient choice and hospital quality for elective patients

Centre for Health Economics (CHE) - 
This paper examines the change in the effect of market structure on hospital quality for elective procedures following changes in 2006 to encourage greater patient choice of hospital in England. The study finds that post-2006, hospital quality was reduced as the probability of emergency readmission was increased for hip and knee replacement patients. 

• Paper
• CHE news

Private healthcare remittal: summary of final report

Competition and Markets Authority (CMA) - 
In April 2012, the CMA started a market investigation in private health care and the final report of the investigation concluded that certain features of the markets for privately-funded health services were leading to adverse effects on competition. This report summarises the adverse effect on competition in the central London market and whether any action should be taken to remedy this.

• Report
• Associated documentation
• Press release

New joints: private providers and rising demand in the English National Health Service

Institute for Fiscal Studies (IFS) - 
This paper explores how NHS reforms to allow for entry of private providers has affected demand for elective surgical procedures. The study found that for elective hip replacements, at least seven per cent of publicly-funded procedures were conducted by private hospitals. Using clinical audit data, the report finds that these additional procedures are not substitutions from privately-funded procedures but that they represent new surgeries.

• Report
• IFS publication

Procurement e-learning tool

Competition and Markets Authority (CMA) -
The CMA with the Crown Commercial Service has worked with Builtintelligence to produce a procurement e-learning tool. It is designed to help procurers and supply chain professionals understand why bid-rigging is harmful, learn how to spot tell-tale signs that suggest a bid may be illegal, deal with suspect bids and know where to go for further help.

• Tool
• Press release

Privatisation and independent sector provision of NHS healthcare

British Medical Association (BMA) - 
This report argues that the independent sector should be subject to the same robust standards as NHS providers and that managers must be wary of the health service becoming fragmented. It calls for government and policy makers to implement a series of recommendations aimed at protecting the NHS from being destabilised. It also urges commissioners and health service managers to consider the possible negative effects of privatisation on training and recruitment.

• Report
• Associated documentation
• Press release

Private healthcare market investigation: provisional findings and remedies

Competition and Markets Authority (CMA) - 
This report outlines provisional findings of an investigation into the private healthcare market and finds that the lack of price competition is harming customers. The CMA are currently consulting on possible remedies to address the concerns it has identified.

• Provisional findings
• Provisional remedies
• Press release

Foundation trust and NHS trust mergers 2010 to 2015

The King's Fund -
Mergers of trusts in the NHS are often instigated by national bodies so that NHS trusts can gain foundation trust status or failing providers can be rescued from financial difficulties. This report looks at 20 mergers between 2010 and mid-2015 and finds that significant sums of money are being spent on such mergers (£2 billion on just 12 mergers over this period), often based on faulty argumentation and a lack of evidence that mergers offer lasting solutions. It concludes that the Department of Health, Monitor and the Trust Development Authority should support service improvement and transformation where possible, rather than instigate merger. If a merger is contemplated, there needs to be a more realistic assessment of the costs and benefits.

• Report
• Blog
• The King's Fund - publications

Outpatient appointment referrals survey

Monitor - 
This survey indicates that too few NHS patients say that they are being offered a choice about where they receive care, indicating that more work needs to be done to promote patient choice across the NHS. 40 per cent of respondents to NHS England and Monitor’s annual survey into patient choice said they were offered a choice of hospital or clinic for their first outpatient appointment by their GPs. The survey indicated that, where patients are offered a choice, they are much more likely to be able to go to the hospital or clinic they want.

• Survey results
• Summary
• Press release

NHS maximum waiting times and patient choice policies

House of Commons Library - 
This briefing  sets out policy on maximum waiting time standards and patient choice in the English NHS. 

• Briefing
• Commons Library publications

The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth

National Institute for Health Research - 
Evidence from the Birthplace in England Research Programme supported a policy of offering ‘low risk’ women a choice of birth setting, but a number of unanswered questions remained. This project aimed to provide further evidence to support the development and delivery of maternity services and inform women’s choice of birth setting: specifically, to explore maternal and organisational factors associated with intervention, transfer and other outcomes in each birth setting in ‘low risk’ and ‘higher risk’ women.

• Report
• Summary
• Abstract