As the policy pendulum seemingly swings back towards integration, a report from the Institute for Fiscal Studies makes interesting reading.
Choosing the Place of Care: the effect of patient choice on treatment location in England, 2003-2011 found a significant shift in NHS-funded outpatient and elective inpatient care. Instead of being treated at their nearest trust, many patients received care at an independent sector treatment centre - but there was “no indication” of patients travelling further for NHS care.
In other words, competition is competition between NHS trusts and ISTCs, not between NHS trusts.
‘It could be that competition between trusts drives quality improvements through fear or professional pride alone’
The study admits more investigation is needed but says “there is no evidence that other trusts are gaining market share at the expense of nearest trusts”.
The numbers involved for ISTCs are substantial.
The data showed the proportions of patients treated at their nearest trust for trauma and orthopaedics and gastroenterology fell by 8.5 and 7.7 per cent respectively from 2006-07 to 2010-11.
England’s ISTCs accounted for 8 per cent of all trauma and orthopaedics first attendances by 2010-11, it said.
The numbers are even more dramatic if the ISTC is nearer to the patient than their closest NHS trust. ISTCs treated 25 per cent of hernia patients where this was the case.
The study is also significant in the debate about whether competition drives quality.
It could be that competition between trusts drives quality improvements through fear or professional pride alone. But the study, commissioned by the Nuffield Trust, couldn’t see numerical evidence of a spur to NHS providers.
More studies required
The authors note two recent studies that concluded choice was associated with lower mortality. However, they said: “In both cases, the indicator of quality (death rates from an acute emergency condition) is far removed from the choice that patients were exercising (where to receive a first outpatient appointment for a non-life-threatening complaint).”
The study also showed an increasingly complicated picture in GP referrals. On average, GP practices referred to 12 providers in 2006-07, by 2010-11 this had increased to 18.
But it also found “an increase in the variation in referral behaviour”.
All of this took place against a backdrop of increasing activity, so while the proportion treated at NHS trusts may have decreased the total number continued to rise.
You don’t hear as much about independent sector treatment centres as you did. However, the IFS report makes the case that their impact is significant and warrants further study.