NHS competition 'may damage care'

When hospitals are forced to compete with each other death rates from heart attacks actually rose, they found.

The decline in standards means patients are worse off even though waiting lists and waiting times have fallen, according to a paper published in the Economic Journal.

Professor Carol Propper at the University of Bristol examined the "internal market" in the NHS created by the Conservative government in 1991. Labour has introduced similar market-based reforms intended to improve health service performance.

She found deaths from heart attacks actually went up in hospitals covered by the reforms. Heart attack death rates are used as an indicator of overall hospital performance.

The decline in performance more than wiped out gains of 7 per cent from improved technology.

The paper "Competition and Quality: Evidence from the NHS Internal Market 1991-9" found waiting lists and times did fall as a result of the market reforms.

But hospitals' overall efficiency levels fell, as managers concentrated resources on measured targets while neglecting others.

Professor Propper wrote: "In the case of competition in the English health care market, quality of care was unmeasured while waiting lists were reasonably well measured.

"The incentives of competition appear to have led hospitals to focus their effort on the easily measured activities to the detriment of the unmeasured, in the process possibly also lowering efficiency."