Wrong sort of competition in NHS claims ex Health boss
Instead of pressing NHS hospitals, foundation trusts and the private sector to compete over individual operations, diagnostic procedures and treatments, the service should be building the integrated clinical networks needed to treat the growing number of patients with chronic disease, he said. Once that was done, patients could be given choice over which network they went to.
Prof Ham, professor of health services management at Birmingham university, said the type of competition that the NHS was adopting “risks fragmenting services for patients”. It could be suitable, he said, for relatively young and fit patients needing one procedure.
“But, increasingly, older patients have multiple or complex conditions that require treatment by integrated teams of specialists, not treatment as a series of discrete, fragmented, problems.
“The quality of specialist services like stroke care will require not only closer collaboration between providers, but also clinical integration between family doctor, hospital and out-of-hospital care,” said Prof Ham, who has written a paper on the issue for the Nuffield Trust health think-tank.
“If you look at the evidence from the US, the highest quality care is delivered by integrated organisations that bring together commissioning and provision – for example Kaiser and the Veterans Administration [which provides for US ex-service personnel and their families].
“Integrated organisations may then compete against each other for patients, but once the patient chooses they get integrated, not fragmented, care.” That allowed specialists to lead the drive for service improvement, he said, and the NHS should be commissioning such clinical networks.
“In the longer term, ministers could then explore how patients might choose between integrated systems, rather than just choose isolated elements of their care.” That would retain the benefits of competition, but with patients receiving a much more seamless service.
“If you take diabetes, the challenge for health, social and community services is to enable patients to self-manage their condition. But when things go wrong, patients need the right service, in the right place, at the right time, with the right expertise instantly available. The services need to work together, with patients not having to work out which part of it they need. That requires collaboration not competition,” he added.
Prof Ham said advocates of choice had not properly thought through the implications of the more atomised approach they had advocated. That, he said, had been developed to reduce waiting lists, not to provide the types of service that large numbers of patients actually needed.
