This is from Private Eye’s edition for 25th November – 8th December 2011.
NHS Reforms
Broken Heart Study
Malcolm Grant, newly appointed chair of the NHS Commissioning Board, recently described health secretary Andrew Lansley’s proposed health reforms as “completely unintelligible”. Now it seems the same applies to the only bit of research David Cameron could come up with to support the bill.
Back in June The PM said: “Put simply, competition is one way we can make things work better for patients. This isn’t ideological theory. A study published by the London School of Economics found hospitals in areas with more choice had lower death rates.”
Certainly the paper, published in the Economic Journal, was billed as showing that “hospital competition in the NHS saves lives”. It looked at the impact of patient choice and hospital competition in relation to elective surgery and concluded, according to lead author Dr Zack Cooper, that “competition in a market with fixed prices can lead to lower hospital death rates and improve patient outcomes.”
Death rates from heart attacks were apparently reduced by an impressive seven percent. There were, it claimed, 900 fewer deaths from heart attacks during the three-year period after the choice and competition reforms were introduced into NHS.
Er … but not according to 11 experts in public health, health economics, general practice and statistics from eight leading universities led by Allyson Pollock of Queen Mary, University of London. In a paper published in the Lancet last month, they argue that there is “no evidence that patient choice in the NHS saves lives” qand claim that the LSE study is daft, or as they put it “fundamentally flawed”.
Among a long list of criticisms, covering data, study design and methods, as well as the report’s analysis and conclusions, they said the LSE researchers had made three very basic mistakes.
Firstly they did not explain why the availability of choice for elective procedures should have any effect on whether heart attack patients survive. For heart attack victims, hospital choice and competition don’t come into it. As Sir Roger Boyle, the government’s former heart tsar who presided over a long-term decrease in heart attack and stroke deaths, told the Guardian, it’s down to the paramedic and ambulance drivers to get patients to the nearest specialist centre as fast as possible. People in acute pain and distress don’t choose.
Secondly, the LSE team didn’t look at whether the availability of choice had nay effect on where patients go for treatment – recent research indicates that most patients pick their nearest hospital.
Thirdly, LSE researchers ignored the effects of changes in prevention and treatment over which Boyle had presided. Heart attack patients tend to fare better when they’re treated in specialist centres in urban areas.
The authors concluded: “Our examination of this research reveals it to be fundamentally flawed, amounting to the conclusion that the paper simply doesn’t prove either cause or effect between patient choice and death rate from acute myocardial infarction.”
The LSE team is fighting back, accusing its accusers in the Lancet of misrepresenting the LSE research and being “politically motivated”. Not an accusation that could be levelled at Cooper and his pro-competition friends at the LSE surely
Others have also blogged on the criticisms of Cooper’s paper advocating greater competition in the NHS. In fact, Cameron’s NHS reforms are highly ideological. He and the other Tories are deliberately privatising the NHS through gradual, piecemeal measures. Furthermore, such privatisation directly enriches the Tories and Tory Democrats, who own and run companies involved in this privatisation. For further information, see the relevant blog posts over at Another Angry Voice, the Void, Vox Political, amongst many others.
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