Internal market harmed patients, new study finds

Competition between hospitals can reduce healthcare quality – leading to increased deaths – according to new research likely to embarrass the government.

A study which measures hospital performance during the Conservatives’ internal market has shown that hospitals facing more competition had higher death rates from heart attacks.

The report, by researchers at Bristol University, has clear implications for Labour’s plans to create foundation hospitals which will be largely free of NHS controls. The reintroduction of competition, allowing foundation hospitals to compete with ordinary hospitals for both patients and staff, could jeopardise quality of care, the research suggests.

Researchers at Bristol looked at hospitals facing competition and those with a virtual monopoly – based on their location – between 1991, when the Tories’ NHS reforms were introduced, and 1999. They charted death rates from heart attacks within 30 days of emergency admission, a measure used to judge healthcare quality in studies in other countries.

Overall, fatal heart attacks fell, in line with international trends thought to be due to improved technology. But the study found that deaths declined more slowly in the hospitals facing competition.

The study found the trend was most noticeable between 1991 and 1995 – when pressure to compete was at its height – but less obvious later, when competition was downplayed. It concludes: ‘We find the impact of competition is to reduce quality.’ The report was presented to a conference run by the National Institute of Social and Economic Research in November.

Carol Propper, one of the study’s authors at Bristol University’s economics department, said the research had ruled out other obvious factors for the difference, such as morbidity. She speculated that hospitals in more competitive areas may have cut their prices at the expense of quality or focussed attention on other priorities like waiting lists.

Opposition to foundation hospitals is mounting with doctors, health unions and leading Labour backbenchers pledged to fight the plans confirmed in the Queen’s speech last month. Health secretary Alan Milburn announced that 12 hospitals would form the first tranche of the scheme beginning April next year. Foundation hospitals would be run by boards made up of patients, council members and local business people and there would be legal safeguards to prevent the sale of hospitals and their assets, he explained.

The BMA has warned that the iniquity could lead to a two-tier service. And Dave Prentis, general secretary of UNISON, said: ‘We need to foster a climate of co-operation between trusts where good practice and innovation is shared, not set one trust against another, in a mad scramble to get more money.’