In the first study of its kind, the outsourcing of NHS care to the private sector has been linked to several hundred preventable deaths over the past eight years.
Researchers from Oxford University have concluded that since 2014 the outsourcing of care to private operators who treat NHS patients has been associated with an additional 557 preventable deaths across 173 of England’s clinical commissioning groups (CCG), “potentially as a result of a decline in the quality of health-care services”.
The peer-reviewed study, which has taken three years to complete, examined the impact of increased privatisation of the NHS following the introduction of the 2012 Health and Social Care Act, which allowed clinical contracts to be awarded to private providers. This led to a rapid change in provision; the total value of contracts awarded to private companies rose by 500 per cent in the two years after the act came into effect. By 2020 private companies were being paid more than £300 million per quarter for outsourced clinical services.
To examine the health impact of increased privatisation, the researchers compiled expenditure data from NHS commissioning groups, which award contracts, and compared it with local rates of treatable mortalities, meaning deaths that could have been avoided through timely and effective healthcare. They found that an increase in outsourcing of one percentage point could be linked to a 0.38 per cent increase in preventable deaths in the following year. (A delay between the arrivals and effects of privatised care meant researchers measured from the year after.)
Ben Goodair, a doctoral student in social policy at Oxford and one of the study’s lead researchers, told the New Statesman that while the first conclusion might be that “private providers are just delivering worse quality of care”, it is difficult to compare outcomes from private care with that delivered by the NHS itself, as they tend to serve different types of patients. A safer conclusion, he said, would be that “outsourcing might be affecting the whole system. By outsourcing, you’re putting more pressure on NHS providers, which might be now dealing with a greater amount of complex cases.”
The NHS has outsourced care to the private sector for decades. However, Goodair noted, the dominant narratives around privatisation and standards in 2012 was that “competition should drive better health quality, in terms of quality of care”, and that “competition between different providers should mean that the best ones rise to the top”. These findings suggest the opposite to be true, however.
The NHS is likely to rely more on private provision in the coming years as it tries to deal with its huge elective care backlog; 6.4 million people are waiting for treatment in England alone. At a recent public accounts committee hearing, Amanda Pritchard, the chief executive of NHS England, said that she intended to “build on” the existing relationships between the private sector and the NHS, noting that private operators will “play an extremely important part” in clearing the backlog.
New commissioning structures, called integrated care boards, will soon replace the clinical commissioning groups. Goodair warned that failure to properly scrutinise the credentials, standards and practices of private operators treating NHS patients could have adverse effects. “Our evidence suggests that to the extent that this [trend of privatisation] continues going on, it might correspond with a further worsening of care,” he said. “We don’t observe that when you outsource more, you have an improvement in the quality of care.”