Refusing Treatment: The NHS & Market-Based Reform
Acta Universitatis Tamperensis, No 1580

By Laura Brereton & James Gubb
December 2010
Distributed by Coronet Books Inc.
ISBN: 9781906837198
111 pages
$20.00 Paper Original

For the past 20 years, the healthcare policies of successive governments have focused to a large extent on developing a market within the NHS in England. The reasoning behind these moves primarily centred on the hypothesis that if competition, in theory and in practice, has proved to be the greatest single spur to efficiency, quality and innovation in other industries, could it not have the same effect in the NHS? 'Refusing Treatment: the NHS and market-based reform' presents the findings of a year-long, in-depth study into whether and why the NHS market has achieved such results.

The study is based on 46 interviews with executives at NHS (foundation) trusts, PCTs, practice-based commissioners and private sector providers, across three health economies in England. Isolated examples of the market having significant positive effects were found. However, by and large, the market is yet to have its intended impact on providers and bring about the anticipated benefits on any meaningful and systematic scale. This is less because the concept of a market is flawed when it comes to the NHS, and more because the market is being distorted and stifled; in particular, by the closed culture of the NHS and powerful, emotive notion of the NHS family. In unprecedentedly tight financial times for the NHS, these findings carry policy implications that should not be ignored.

About the Author

Laura Brereton holds an MSc in public health/health services management from the London School of Hygiene and Tropical Medicine and a BSc from Boston University (US). She has worked extensively on the impact of ongoing market reforms in the English NHS. Laura is currently a health policy researcher at RAND Europe, where she focuses on health system comparison and chronic disease management. She worked previously in public affairs for health and medical associations in the US and UK. James Gubb is Director of the Health Unit at Civitas, a post he has held since 2007.

His previous publications on health include Checking up on Doctors: a review of the Quality and Outcomes Framework and Putting Patients Last: How the NHS keeps the ten commandments for business failure (with Peter Davies). James also sits on the steering committee of Young Civitas for Medics, a new society set up to involve medical students in health policy discussions, and is a partner in Streetscape, a landscape gardening business that strives to take unemployed young people back into work. He is a regular contributor to print, broadcast and healthcare media on issues concerning the NHS.

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