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April 6, 2011

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» The NHS and Competition

The NHS in Wales and England have been on a different trajectory over the role of competition in healthcare for some time. The role of competition is contentious, but recently the work of economists like Carol Propper[1] has been important in … Continue reading

» The NHS and Competition

The NHS in Wales and England have been on a different trajectory over the role of competition in healthcare for some time. The role of competition is contentious, but recently the work of economists like Carol Propper[1] has been important in apparently settling the question of whether or not competition is effective in improving the quality of healthcare. The contention that competition on price drives down quality, but competition in the context of regulated prices (the English system of Payment by Results based on national tariffs) saves lives at no extra cost has had a lot of publicity and has been influential.

However, what seems to have been established is a correlation between competition and health outcomes (mainly centring on Acute Myocardial Infarction (AMI)) – but causation is not, I think, established satisfactorily; Gaynor et al (2010) do not take a whole system perspective, largely ignore the role of teaching hospitals and clinical networks (which are fundamental to cardiac care); and omit the advent of the NSF for Coronary Heart Disease in 2000 as a relevant policy to improving outcomes! The idea that patient choice policy beginning in 2006 would have a discernable impact on the figures for AMI by 2007/08 seems to be very unlikely – especially in the context that AMI is an emergency, not elective – and overall only 45% of patients remembered being offered a choice at all. (There is no comment on the proportion of this 45% who actually went on to exercise choice).

In the context that I think the jury is still out on the impact of competition, my perspective on NHS Wales includes the following:

  •  integration and co-ordination are more important than the last Labour UK Governments’ version of choice and competition, because most people using the health service are older people with multiple health and social issues;
  •  it is fundamental to make our system work well to demonstrate that there is an alternative to the English system. At the moment commentators like Chris Ham are dismissing the Welsh approach because the Welsh NHS ‘lags behind England on some metrics’. We must be in a position to demonstrate progress on metrics that make sense to us in Wales, including on health outcomes and on process metrics that matter to the public, like waiting times; 
  • Wales’ integrated model has the potential to deliver integration and co-ordinated care, co-produced with communities, patients and carers, but only some of the mechanisms to counterbalance unresponsive bureaucracy are in place. In particular, there needs to be greater local democracy. The potential for mutual models (without asset transfers) to give everyone within a health board area a stake in their board’s governance is worth exploring. There is also a role for development support, regulation and peer review.  Appendix 1:http://wihsc.glam.ac.uk/documents/download/26/ shows a model created as part of WIHSC’s response to the NHS reorganisation consultation in 2008 that indicates how the various elements of the system could link together;  
  • Wales needs to acknowledge and work in partnership with the private sector because it has a role in health and social care that impacts profoundly on some of the intractable problems of NHS Wales (including inappropriate admission and delayed transfers of care). Domiciliary and residential and nursing home care is largely run by private companies in Wales. Designing services with the private and voluntary sector as partners rather than just commissioning services from them could lead to much more innovative and responsive services; however
  • the UK Coalition policy on GP commissioning of any qualified provider is likely to lead to a pre-1948 patchwork quilt of services and the dissolution of the NHS as we know it.

 If there is to be competition in England, this should be between integrated organisations akin to our health boards that plan, commission and provide integrated health and social care, including some aspects of housing.

The planning and (re-) design of services needs to be co-produced with citizens, patients and carers, but clinically led by multi-specialty groups that include primary and secondary care clinicians. As well as not creating artificial barriers between primary and secondary care as the English system will, multi-specialty groups under the wing of the Welsh Health Boards would also recognise the reality that the most powerful clinicians, chief executives and finance directors are (and always have been) co-located in acute (secondary and tertiary) settings. One of the main reasons that LHBs and PCTs have struggled is that they are on the wrong end of the knowledge-power axis. I think that this is a fundamental fault line that means that even with substantial amendment to the UK Coalition Government’s Health and Social Care Bill that now seems to be in the offing, the English experiment will not work. 

 Written by Julia Magill, Visiting Senior Fellow WIHSC  

[1] see, for example,  Gaynor M, Moreno-Serra, R and Propper, C (2010) Death by Market Power: Reform, Competition and Outcomes in the National Health Service. Bristol: Centre for Market and Public Organisation, University of Bristol.

February 24, 2010
» Long time, no see

It’s been a while since we last gave you an update on what the Glamlife Team have been up to (we’ve carried on being Busy, busy, busy!), so here’s a flavour of the latest Glamlife developments…

We know from our Glamlife poll at the beginning of this month that 55% of those of you who took part aren’t aware that the ‘Your Documents’ tab at the top of your Glamlife homepage leads you to Google Docs. As a result of this, we’ve created a page in the Glamlife Directory designed to give you an overview of what Google Docs can offer, along with some helpful tips. We’re also aware that our students have had some problems using Google Docs because previously every file needed to be converted into a Google Doc file in order to be saved. Google have made some changes so now you can upload, store and organise any type of file in Google Docs – far more handy! Read more about this in the Official Google Docs Blog.

The Glamlife Team have been busy beavering away this term to bring you feature articles on St Dwynwen’s Day, St Valentine’s Day and St David’s Day – don’t forget to check out the St David’s Day events happening on Treforest campus and locally in Rhondda Cynon Taf and Cardiff. Have you also read our recent article about making sure you’re fraud savvy?

We’ve also been busy adding new pages to the Glamlife Directory:

  • presentations, which includes information about all the help you can get around the University
  • Listening to You, which is the University’s place to tell you all about what we are doing with the feedback you as students give us
  • attendance, which is a great reminder of how important it is to attend all your lectures
  • self-directed study, which includes some helpful links to assist you settle down to your studies.

If there’s anything you’d like us to write a feature on, or a topic you’d like us to cover for the Glamlife Directory, don’t hesitate to let us know by emailing glamlife@glam.ac.uk. We’re also always looking for feature articles written by students, just like this one on the Art of Rejection, so if you fancy trying your hand at some creative writing or investigative journalism, get in touch! You can even get some experience for your CV by doing a feature writing Work Taster with the Glamlife Team.

And finally, did you take part in our recent Valentine’s competition? We asked you to tell us how much you love Glamlife, and the Glamlife Team were inundated with over 80 entries – some of which made us laugh, most of which made us smile, and only the odd one that made us somewhat nervous ;) Look out for some of the more passionate entries popping up on Glamlife in the near future (hope you all read the competition rules – we did warn you!).

November 6, 2009
» Busy busy busy …

Well it’s been a busy term so far for Glamlife, and it’s showing no sign of slowing down! Read on to find out what’s been happening and what’s in the pipeline …

You can now take a peek at today’s menus to whet your appetite before you visit Stilts Food Court or Crawshay’s (on the Treforest campus) or Zone (on the Glyntaff campus). You can get to the daily menus via Glamlife’s campus facilities page – here you can learn more about the facilities on all three campuses, including the rest of the catering outlets (which have standard rather than daily menus).

Students can now subscribe to RSS feeds for various areas of Glamlife, including the Marketplace and the Glamlife Directory. For information about RSS feeds and how you can subscribe to them, read our RSS feed feature article.

Marketplace has launched successfully, growing steadily in popularity since the first week of term when 20% of students who voted on our Glamlife poll had already used or were planning to use the Marketplace to sell or buy items and post notices. At the moment, you can reach the Marketplace by clicking on the tab at the top of Glamlife, but we can now reveal that the Glamlife home page will shortly be revamped to include more functionality that we think students will find beneficial … this includes a Marketplace feed so you’ll be able to see the latest Marketplace posts without even having to leave the home page!

We’ve been pleased to hear on the grapevine that more and more of you are using Google Docs. There are some helpful links under the ‘Using Google Docs’ heading in the Glamlife walk-through guide, and the Official Google Blog also has some great tips for students and information on new back to school features.

The Glamlife Effect has continued to gather pace, with many of the 900 students who attended the recent Part-Time Jobs Fair, hosted by the Careers Service and the Students’ Union, reporting that they found out about the Fair from the promo on the home page of Glamlife. It’s great to know so many of you are finding out what’s happening around the University via Glamlife – keep an eye out for more events in the coming weeks!

And last but not least, Christmas will be coming early to Glamlife as we will be holding another competition with a brand-new laptop as the prize! So look out for details, and don’t forget to tell your friends …