Rapid Responses to:

ANALYSIS: Chris Ham Competition and integration in the English National Health Service BMJ 2008; 336: 805-807 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Competition and integration in English National Health Service

Robert S Elkeles   (15 April 2008)

Collaboration rather than competition is the way forward

Rodney Burnham, Mike Cheshire, Clare Gerada, Simon Lenton   (18 April 2008)

Competition and integration in English National Health Service 15 April 2008
Robert S Elkeles, Cosultant Physician Professor of Diabetic Medicine Imperial College Healthcare NHS Trust St Mary's Hospital Praed Strret London W 2 1 NY Send response to journal: Re: Competition and integration in English National Health Service	Competition and integration in the English National Health Service Chris Ham has reached the conclusion that the market approach to healthcare may not be appropriate for disease prevention and chronic disease and argues for integration in healthcare. It has been clear to most working in the NHS that the so called market has been inappropriate for health care since it was introduced in the 1990’s 2. The idea of competition between health providers and the purchaser provider split is espoused by most politicians, journalists and health economists in the belief that this is only way to motivate people in the NHS work harder and improve efficiency .In fact the market sets different parts of the NHS against each other and lead to a fragmented approach rather than ensuring that all work together for the welfare of patients.. It sets primary against secondary care and both against social services. For instance, patients are frequently denied a specialist opinion by their PCT purely for financial reasons. Is this good care? Ham points to the weaknesses in commissioning. How ridiculous it is to exclude secondary care specialists who have spent their professional lives studying their field from this process. As Ham points out the whole process of negotiating contracts for services in the market is hugely costly. This money does not contribute to patient care. Millions could be re-directed to direct patient care, disease prevention programmes and hospital building by getting rid of this wasteful market approach and also by ridding the NHS of the armies of management consultants. Let us return to a system in which healthcare is planned for a given population by, for instance a health authority, on which all parts of the NHS are represented. This would ensure an integrated approach and would restore professionalism, pride and satisfaction in working in the NHS which have all been so diminished by the demeaning market approach. By all means let health providers compete and be rewarded for providing an excellent and efficient service. Robert Elkeles Consultant Physician and Professor of Diabetic Medicine, Imperial College Healthcare NHS Trust, St Mary’s Hospital, Praed Street London W2 1NY Robert.elkeles@kelear.co.uk 1.Ham C. Competition and integration in the English National Health Service. BMJ 2008 336 805-807 2.Elkeles R. The cash register may drown out the sound of the ambulance. The Independent 26th Jan 1989 Competing interests: None declared
Collaboration rather than competition is the way forward 18 April 2008
Rodney Burnham, Registrar Royal College of Physicians of London, Mike Cheshire, Clare Gerada, Simon Lenton Send response to journal: Re: Collaboration rather than competition is the way forward	We are interested in the article by Chris Ham (1) on 12 April; we are also generally in agreement with it. Next week we will publish Teams without Walls. (2) This is a joint document from the Royal College of Physicians, the Royal College of General Practitioners, and the Royal College of Paediatrics and Child Health and endorsed by the NHS Alliance. Our thesis supported by evidence is that close partnership between generalists and specialists is the key to high quality patient care. This care should be within teams not bounded by the bricks and mortar of institutions. These teams cross the primary secondary interface and provide care most appropriate to the needs of patients, although we feel that hospital services should be part of an integrated team even in urban areas. As part of our work, we surveyed the Members and Fellows of the Royal College of Physicians and Royal College of General Practitioners. Over 300 examples of medically led, innovative, clinical integration schemes were reported. These often occurred in spite of the disincentives inherent in the competitive environment. We believe that collaboration rather than competition between organisations is the way forward and that doctors should be encouraged to develop services further. However, doctors are by nature competitive and knowing that they can provide the best service possible is all the stimulus that they should need. With best wishes, Yours sincerely, Rodney Burnham, Mike Cheshire, Royal College of Physicians, Clare Gerada, Royal College of General Practitioners, Simon Lenton, Royal College of Paediatrics & Child Health (1) Ham C. Competition and Integration in the English National Health Service BMJ 2008; 336: 805-807 (2) Royal College of Physicians, Royal College of General Practitioners and Royal College of Paediatrics and Child Health. Team without walls: the value of medical innovation and leadership. Report of a working party. London: RCP, 2008. Competing interests: None declared