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More use of private sector could cut NHS waiting lists

BMJ 1999; 318 doi: (Published 12 June 1999) Cite this as: BMJ 1999;318:1578
  1. Richard Woodman
  1. London

    Thousands of patients on long NHS waiting lists could be treated quickly in private hospitals if the two sectors collaborated instead of viewing each other with suspicion and barely suppressed hostility, according to a report from the free market Adam Smith Institute.

    The report, by Nick Bosanquet, of Imperial College, London, said: “At present, there is underoccupation in private hospitals, with occupancy rates at 50% or less. The NHS would be able to buy treatment quickly for at least another 100 000 patients a year.” Urging the NHS to move to a system of managed pluralism, the report suggested that the benefits of this model have already been shown in other areas, such as the long term care of elderly people.

    Professor Bosanquet argued that the model of greater cooperation between the public and private health sectors could also remedy the United Kingdom's poor international standing in services for cancer and heart disease. In the case of cancer, he cited the example of the successful development of new systems for improving information about cancer care by Salick, the US healthcare subsidiary of the pharmaceutical company Zeneca. In heart disease the benefit of public-private partnership was illustrated by projects in smoking cessation which were proving very successful in the United States because of the rapid spread of innovative treatments. In contrast, the more centralised UK approach was likely to achieve quite slow results, argued the report.

    The report suggested that the treatment of severe mental illness would also improve if the NHS stopped using the private sector simply as a safety valve and began contracting on a longer term basis for places of clearly defined quality: “The covert competition with the private sector has disturbed NHS priorities and made it more difficult to achieve its goal of concentrating resources on people in health need…. The NHS actually performs best when it comes closest to the pluralistic model, with specific targets and clear personal responsibility for achieving them.”

    A Successful National Health Service is available from the Adam Smith Institute, price £14.

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