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Sunday 15th September 2019

NHS reforms under the microscope

20th January 2014
Microscope (Feature)

When Andrew Lansley, previous health secretary, announced the new healthcare reforms 16 months ago they were lambasted by GPs. This included a very public confrontation on an episode of Question Time in 2011, between himself and Dr Phil Hammond.

Has marketisation worked?

According to Dr Hammond, the healthcare reforms have not gone according to plan. Some GP commissioners he has spoken to firmly believe the NHS is not being privatised and point to benefits they have made for patients in their area that have been made possible by the legislative changes. But the majority hold the opinion that the reforms aim to push as many services out for tender as possible.


You’re not alone. NHS England has delayed the publication of its 'choice and competition' framework because of a 'paucity of evidence' of the benefit to patients. Even with £9 billion of NHS business now belonging to the private sector, the predicted surge of private takeovers of community services has yet to happen. 

Potential Reasons

This could either be because commissioners are struggling to integrate and collaborate rather than swapping existing NHS providers who are doing a good job; or because the private sector is unable to identify the profit margin in NHS services to satisfy their shareholders.

In the original argument on Question Time, Dr Hammond highlighted the risk that patients who are easiest to cure will be targeted in the competitive market. This will leave those with more expensive treatment needs without funding. Today, he still argues that there is 'no evidence that a competitive market in healthcare will make the service fairer, or better for those who need really complex care'.


Dr Hammond believes that the best option for NHS services would be to 'integrate primary, secondary and social care into a single organisation'. This will facilitate improved co-operation between services and create a better structural and financial basis for municipal services. 


Can marketisation support the integration of healthcare services? Dr Hammond does not seem to think so, saying it would be 'very difficult to get that level of integration when you splinter it up with competition'.

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