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. 2023 Dec:138:104941.
doi: 10.1016/j.healthpol.2023.104941. Epub 2023 Nov 4.

'Accident and emergency'? Exploring the reasons for increased privatisation in England's NHS

Benjamin Goodair  1
Affiliations

'Accident and emergency'? Exploring the reasons for increased privatisation in England's NHS

Benjamin Goodair. Health Policy. 2023 Dec.

Abstract

England's NHS is experiencing rising privatisation as services are increasingly being delivered by private healthcare providers. This has led to concerns about the supposed benefit of this process on healthcare quality but the reasons for the increase - and whether processes prioritise quality - are not well understood. In-depth semi-structured interviews with 20 people involved in the commissioning process, sampled from 3 commissioning sites (regional health boards) are thematically analysed. Four key themes of reasons for outsourcing were identified: unmet need; the "choice agenda"; appetite for change amongst key individuals working at the commissioning body; and the impact of financial pressures. The study concludes that the experience of commissioners navigating the provision of healthcare with worsening social determinants of health and financial austerity means that decisions to use private providers based on anticipated quality are sometimes but not always possible - sometimes they constitute 'accidents', sometimes 'emergencies'.

Keywords: Commissioning; Contracting-out; Health policy; NHS; Outsourcing; Privatisation; Quality.

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Conflict of interest statement

Declaration of Competing Interest The authors declare there is no conflict of interests.

Figures

Fig. 1:
Fig. 1
Scale of increase in private provision of NHS services 2011–22. Data source: RTT waiting time data (NHS England, 2022). Replication materials available at https://github.com/BenGoodair/NHS_privatisation_treatments
See this image and copyright information in PMC

References

    1. Liu X., Hotchkiss D.R., Bose S. The effectiveness of contracting-out primary health care services in developing countries: a review of the evidence. Health Policy Plan. 2008 Jan 1;23(1):1–13. - PubMed
    1. Kruse F.M., Stadhouders N.W., Adang E.M., Groenewoud S., Jeurissen P.P.T. Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review. Int J Health Plann Manage. 2018;33(2):e434–e453. - PMC - PubMed
    1. Department of Health and Social Care. GOV.UK . 2010. Equity and excellence: liberating the NHS.https://www.gov.uk/government/news/equity-and-excellence-liberating-the-nhs [cited 2023 Jun 27] Available from:
    1. Liu X., Hotchkiss D.R., Bose S. The impact of contracting-out on health system performance: a conceptual framework. Health Policy. 2007;82(2):200–211. - PubMed
    1. Vining A.R., Globerman S. Contracting-out health care services: a conceptual framework. Health Policy. 1999;46(2):77–96. - PubMed

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