Yes, we've said 'competition' and 'NHS' in the same sentence


There are certain ‘danger words’ you’re not supposed to use when talking about the NHS. These include ‘privatisation’ and ‘competition’. Usually it doesn’t really matter if you’re prescribing something or not; the mere use of the word leads to total destruction (i.e. a lot of yelling and inaccurate statistics thrown around about America). Perhaps the usual absence of these words explains why the NHS continues to fall short in international rankings, and received a below-average DEA score from the OECD, even when compared to similar, publicly funded and run healthcare systems.

But a  new report from the Economic and Social Research Council has dared to mention the unmentionable – and as it turns out, competition is key to bettering public hospitals, from management practices to patient outcomes, including mortality rates:

The report The Impact of Competition on Management Quality: Evidence from Public Hospitals, building on ESRC-funded research, shows that hospital competition can improve healthcare by improving the quality of management practices. The research measured the management quality of 100 public hospitals through a management survey of clinicians and managers, and used data published by the government to assess the performance of NHS hospitals in England.

Key findings • Hospital competition is useful for improving management practices and outcomes in healthcare. • More hospital competition leads to improved hospital management and higher hospital performance in terms of quality, productivity and staff satisfaction. • Management quality is linked to improved indicators of hospital performance including clinical quality, mortality rates and staff turnover rates. • Hospitals with higher management scores also had shorter waiting times, lower MRSA infection rates and performed better financially.

This report will probably come as a surprise to many, but only because competition is not allowed to be part of the debate.

The DEA scores I mentioned above: when comparing publicly funded, publicly run systems, some countries actually do quite well. Norway and Italy have high DEA scores, and Poland ranks above average; but in all three cases, there is more choice among providers. (The OECD actually flags up how restricted choice is in the UK.)

I’m not crying ‘correlation equals causation’ here (Sam and Ben would kill me) – but this new research only adds to the evidence that competition in the healthcare sector – public or private – might not be such a terrible thing to bring up after all.