NHS privatization drive linked to rise in preventable deaths, study suggests | NHS

The privatization of NHS care accelerated by Tory policies a decade ago has been consistent with a decline in quality and ‘significantly increased’ death rates from treatable causes, says the first study of its kind.

The hugely controversial health service in England in 2012 by the Health Minister, Andrew Lansley, in the Tory-Lib Dem coalition government, forced local health authorities to tender contracts for services.

According to the historic assessment, billions of pounds of taxpayers’ money have since been handed over to private companies to treat NHS patients.

It shows that the growth of healthcare contracts outsourced to private companies has been associated with a decline in the quality of care and higher treatable death rates – deaths of patients deemed avoidable with timely, effective healthcare.

The analysis from the University of Oxford is published in the journal Lancet Public Health. “Privatization of the NHS in England, through the outsourcing of services to for-profit companies, has steadily increased [after 2012],” it says.

“Private sector outsourcing corresponded to significantly higher treatable death rates, possibly due to a decline in health care quality.”

With a record 6.5 million patients now waiting for care, and private companies lining up to help clear the backlog exacerbated by the Covid-19 pandemic, the study will raise new fears about the potential harm of the increased outsourcing of NHS care.

“Our Study Suggests More Profitable Outsourcing From Clinical Clients” [CCGs] in England could have negatively impacted the quality of care provided to patients and led to increased death rates,” the authors said.

“Our findings suggest that further privatization of the NHS could lead to poorer health outcomes for the population.”

Chart: Deaths from treatable causes over time

The study examined the impact of the Health and Social Care Act 2012 in England, which “increased pressure on the NHS to outsource services from state-owned companies to private, for-profit providers”.

Researchers analyzed data showing how much 173 CCGs in England spent on outsourcing between 2013 and 2020, which grew from 3.9% to more than 6.4%. In total, £11.5 billion was handed over to private companies during the period, although the amount varied considerably between CCGs.

The analysis shows that a 1% annual increase in outsourcing expenditure is associated with a 0.38% increase in treatable mortality — or 0.29 deaths per 100,000 people — the following year. Researchers claim that 557 additional deaths between 2014 and 2020 can be attributed to the increase in outsourcing.

The authors speculated that the higher mortality could be due to private companies providing “poorer quality care, resulting in more health complications and deaths,” or because greater competition for contracts could cause for-profit providers to prioritize services. shorter waiting times “at the expense of quality of care”.

“While some have argued that the Health and Social Care Act would improve the performance of health services by increasing competition, our findings add merit to long-standing concerns that it could instead lead to cost savings and worse health outcomes,” said the head of the investigation, Benjamin Goodair. from the University of Oxford.

dr. David Wrigley, deputy chairman of the British Medical Association, said the doctors’ union had repeatedly expressed concern about ministers “throwing huge amounts of money to private companies rather than investing in rebuilding our health and care system”.

“A policy of outsourcing with minimal oversight, governance or transparency will lead to reduced quality and poorer patient care, which is exactly what today’s Lancet study shows,” he said.

The waiting list for NHS care in England reached 6.5 million this month. dr. Danny Bhagwati, Vice-President of the Doctors’ Association, said: “Given the magnitude of the backlog and the solutions proposed using the private sector, these data highlighting the risk to patient safety should lead the government to look to the regulation of this sector urgently.”

Further analysis looked for a link between outsourcing and preventable death – deaths that were avoidable with effective public health rather than medical interventions.

None were found, suggesting that the relationship between outsourcing of NHS services and treatable deaths is related to quality of care, and not as a result of general trends in population health outcomes.

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“We have been sounding the alarm for years about the false promotion of outsourcing as better for healthcare and better for the NHS,” said Alan Taman, a spokesperson for the campaign organization Doctors for the NHS. “This confirms what we have said.”

The authors acknowledged several limitations of their study. Their findings do not prove a causal relationship between outsourcing and death, so other factors cannot be ruled out.

Nigel Edwards, the chief executive of the Nuffield Trust, warned that the study “leaves many questions unanswered — not least whether outsourcing is directly responsible for these results or simply associated with them.”

The study co-author, Dr. However, Aaron Reeves, from the University of Oxford, said: “These results have clear implications for the debate over privatization of the NHS, suggesting that more outsourcing to the private sector could lead to a decline in the quality of care provided to patients. provided.

“While more research is needed to pinpoint the exact causes of the declining quality of health care in England, our findings suggest further increasing privatization of the NHS would be a mistake.”

When NHS outsourcing has run into trouble


In 2012, Circle became the first for-profit health company to take charge of an NHS hospital when it took over Hinchingbrooke Hospital in Cambridgeshire. However, it returned the contract to the NHS in 2015 after the hospital ran into financial difficulties and was unable to keep up with rising demand for care, which the Care Quality Commission described as “inadequate”.

eye care

Vanguard faced legal action over a series of eye surgeries performed in 2014 at Musgrove Park Hospital in Somerset. A confidential report on Vanguard said the surgeries appeared rushed and surgeons were allowed to continue practicing even after patients reported serious complications. The hospital ended his contract with Vanguard after just four days.

Mental health

The major private mental health hospital chains that treat NHS patients have been criticized dozens of times over the past decade by coroners and investigative juries for providing unsafe care. The Priory, Cygnet and Elysium have been censored at least 37 times for errors and omissions in care involved in the deaths of patients, including several children.

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