Collaboration, not competition, that’s what we need says Polly.
Quite ignoring the fact that markets are the way that human being collaborate. Sigh.
She uses as her example, as the way that collaboration works, the decline in deaths from heart attacks.
But destructive fragmentation is what the new competition system will do, Boyle says. He has stopped vainglorious consultants competing, except to become the single local centre of excellence. He was wrestling with reducing the number of child heart units as he left: the Royal Brompton, losing out, has gone to judicial review – to the NHS chief executive’s reported fury at the waste of money – but specialism has to be concentrated. These are necessary rationalisations that can only be done by an overall authority bringing local doctors together: 500 consortiums are not the answer. He gives one example of how the new GPs’ consortiums risk disrupting treatment with arbitrary behaviour: in every area one specialist hospital is always open on a rota for heart attack and stroke patients. Wigan and Whiston, nine miles apart, take it in turns. But one consortium refused to send its patients to the other town – so the system breaks down in fragmentation and daft localism. That’s competition instead of collaboration. “Look at our results. Now show me any evidence that NHS competition achieves as much.”
Yet economists using econometric analysis say they can prove competition works – and that’s what cuts heart deaths. What’s more, they say their measurements of heart deaths hold good as a model for all treatments. Boyle ripostes that it’s “bizarre to choose a condition where choice by consumer can have virtually no effect”. Patients suffering “severe pain in emergencies clouded by strong analgesia don’t make choices. It’s the ambulance driver who follows the protocol and drives to the nearest heart attack centre”. From 2002 on, “groups of clinicians and managers across England have been working together, collaborating, to bring about improvement in outcomes”.
But the thing is, those economists can show this.
“Dr Cooper and colleagues looked at data for 433,325 patients who had heart attacks between 2002 and 2008 – covering the period before and after fixed-price competition was introduced – at 227 hospital sites in England.
They found that death rates dropped by about 7 per cent under the new regime, and fell quicker in “more competitive markets”. The number of patients being treated also fell.”
Note the important point there: heart attack rates are falling everywhere, have been for years. So have survival rates been rising for decades. It’s that the improvement in survival rates was greater where there is competition.
It’s not that the patient making a choice improves the treatment the patient gets. It’s that the patient having a choice, whether exercised or not, reduces the manner in which the local hospital is a monopoly and thus improves the performance of said hospital.
Come on, it’s hardly an unusual finding that a monopoly offers crap service/prices now, is it? In fact, I find it really quite worrying that there’s quite so much doublethink around. The very same people who point to the big six energy suppliers ripping off their customers as an oligopoly insist that such could never happen in the NHS monopoly. What sort of cognitive dissonance do you have to suffer from to believe both those things?
We’ve direct evidence that competition saves lives: yet still there are people who reject competition in the name of saving lives.