NHS market reforms are not linked with better care

Research by the think tank Civitas looked at more than 150 published studies of market reforms introduced to the NHS both under a Conservative government in the 1990s and under the present Labour government since 2002.

Purchasers and providers often feel they are at odds and are pushed to have different objectives

Analysis concluded that although waiting times have shortened, and patient access and provider efficiency have improved, much of this can be attributed to greater funding and the use of targets, rather than the introduction of the purchaser/provider split.

The report accepts that the policy changes have increased awareness of costs, efficiency and accountability in the NHS. But it says improvements that might be expected, including large scale cost reductions, service innovation and provider responsiveness to patients and purchasers, had not materialised.

The report says many researchers could not attribute any improvements specifically to post-2002 reforms such as payment by results, foundation trusts, primary care trust commissioning and patient choice.

Instead, it suggests any improvements can be attributed to a combination of “targets and terror” and increased spending.

Civitas health policy researcher Laura Brereton, who is the report’s lead author, said: “There was lots of money coming into the NHS at both times when market policies were being introduced, so it’s hard to say if changes were due to more resources or because of the market functioning.”

The report said the lack of a stable policy environment had demotivated staff, and that patients and the public still do not understand the changes introduced to the NHS.

Ms Brereton said the “costs” of market reforms were not necessarily financial.

“Researchers found that the relationship between the providers and the commissioners had changed,” she said.

“Purchasers and providers often feel they are at odds and are pushed to have different objectives, even when they should both theoretically be working with a shared first priority of improving patient care.”