Competition 'won't add quality'

There is no evidence that competition will drive up quality in the NHS, an academic commissioned by the Department of Health to analyse NHS reforms has said.

Using 'some' market mechanisms was reasonable, Professor Sheila Leatherman of the University of North Carolina said, but 'where is the evidence that competition improves quality?'

Published research does not back the use of competition, she added. But deputy chief medical officer Professor Martin Marshall said the introduction of 'supply side' reforms, bringing private and voluntary sector companies in to provide NHS services was a vital part of moves to improve patient care. 'We are moving quite ambitiously into using competition,' he said.

Speaking to clinicians and managers at the International Society for Quality in Healthcare meeting in London, Professor Leatherman said patients would not respond to competition.

In both the US and UK, 'consumers don't vote with their feet and they don't want to vote with their feet,' she said.

Publishing performance indicators would 'galvanise' providers into doing better rather than make a difference to where patients go for healthcare.

Professor Leatherman criticised a 'political expediency' behind some of the reforms and called for a focus on what matters to patients.

'There needs to be a concerted effort by all to look at what can make a difference to illness or suffering,' she said.

The deputy CMO warned that doctors were increasingly negative about some aspects of reform.

DoH research showed that 73 per cent of consultants and 66 per cent of GPs disagree with government reforms while 70 per cent of both groups are critical about the NHS when they talk to friends and family.

But Professor Leatherman said the public were enthusiastic about the NHS. Nearly half of the public said only minor changes were necessary. Just 15 per cent of the UK population said the healthcare system was so bad it needed to be 'completely rebuilt', while double that number in the US agreed with the statement about their own country.