NHS reform bill: what the research says

Operation 11 October 2011

The debate in the House of Lords on the Health and Social Care Bill highlights the many proposed changes to the health service - called "the biggest shake-up of the NHS since its creation". Among the proposals are:

  • An independent NHS Board to allocate resources and provide commissioning guidance
  • An increase in GPs' powers to commission services for their patients
  • Cut administration costs by reducing the amount of structural institutions, including the removal of Primary Care Trusts and Strategic Health Authorities
  • Develop regulator Monitor to oversee NHS access and competition

A number of ESRC-funded research projects have looked into NHS provision and how to improve delivery of the health service.

Patient Choice, Hospital Competition and Health Care Quality: Evidence from the English National Health Service is a current ESRC-funded research project examining the impact on quality, efficiency and equity from the market-based reforms introduced in 2006 to increase patient choice and introduce provider competition.

Findings so far indicate that the NHS reforms improved hospitals’ access, quality and efficiency, without harming equity or prompting providers to 'cherry-pick' healthier patients for care. The evidence suggests that hospital competition within fixed-price markets can lead to improvements in quality and efficiency without harming equity.

Traditional boundaries and poor communication between groups of staff can be a challenge to improvement. The research project Learning across occupational and organisational boundaries within Treatment Centres: the implications for clinical quality and patient safety, led by Dr Justin Waring, compared the working relationships of Day Surgery Units in two NHS and two Independent Sector Treatment Centres (ISTC). Although ISTCs have led to more standardisation and control over clinical practice, there is resistance to changing institutionalised working practices.

Research from the Centre for Economic Performance (CEP) shows that competition, improved management and pay regulation are factors influencing the overall delivery of health services. The contentious issue of competition has been examined in the Working Paper Does Hospital Competition Save Lives? Evidence from the English NHS (PDF, 1.93Mb).

The authors conclude that competition has a positive effect. Hospitals facing more competition took steps to improve their quality and management, resulting in lower death rates and improved patient outcomes.

The positive impact of competition on management was confirmed in the CEP Discussion Paper The Impact of Competition on Management Quality: Evidence from Public Hospitals (PDF, 241Kb). The researchers found that hospitals located in more competitive markets tended to be better managed, with lower death rates.

Improved hospital management is found to be strongly related to health outcomes, such as lower death rates and higher quality of care. Better managed hospitals are also more productive, according to the report Management in Healthcare: Why good practice really matters (PDF, 877Kb).

NHS pay regulation, where variation in pay between high cost and low cost areas is restricted, ultimately has an impact on death rates, concludes the paper Can Pay Regulation Kill? Panel Data Evidence on the Effect of Labour Markets on Hospital Performance (PDF, 278Kb). The pay regulation means that it is difficult to retain high quality staff in high-cost areas such as London and the South East - leading to greater death rates.

Professor Nicholas Bacon and Dr Peter Samuel has evaluated the process and outcomes of pioneering labour-management partnerships in NHS Scotland, launched in 1998. Their recent project Evaluating Labour-Management Partnership in NHS Scotland studied the main strategic and organisational challenges, as well as identifying and explaining main outcomes.

Dr William Fear is examining how the issue of patient safety is affecting the NHS. Several improvement programs have been launched over the past decade, but with inconsistent implementation and little evidence of improvement. Healthcare Management: The Management of Patient Safety examines the structural response of organisations to the demand for patient safety improvement.