Regulating the NHS market in EnglandBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1608 (Published 11 March 2013) Cite this as: BMJ 2013;346:f1608
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Professor Chris Ham writes that “Evidence that competition in healthcare is beneficial is both equivocal and contested. Even where benefits can be delivered, these have to be set against the considerable transaction costs involved in contract negotiations between commissioners and providers and the work of the regulators.”
The British Association of Dermatologists agrees. Prof Ham might also have added to these cautionary considerations, the risk of conflicts of interest, a topic dealt with comprehensively but alarmingly by Gareth Iacobucci a few pages before. This BMJ investigation found that “conflicts of interest are rife on CCG governing bodies, with 426 (36%) of the 1179 GPs in executive positions having a financial interest in a for-profit private provider beyond their own general practice—a provider from which their CCG could potentially commission services.”
It is shocking that Michael Dixon, chairman of the NHS Alliance and interim president of NHS Clinical Commissioners, has called for “more leniency” in handling conflicts of interest, declaring that “the priority is to move services out of hospital and into primary care. The reason this hasn’t happened to date is because of blocks in the system. It’s more important to remove those blocks than be preoccupied with conflicts of interest.” How can a senior official so nonchalantly shrug off financial conflict of interest and the risk of corruption, in justification of a controversial political objective - removing services from hospitals? Are probity and fiduciary duty to be seen as 'blocks in the system'? After North Staffs and the Francis report and the gagging orders scandal, what next?
Competing interests: No competing interests