By Professor John Robertson, OBA

Thanks again to AR for alerting me to this.

Gillian Bowditch is a columnist for The Sunday Times. She is founder of the personalised jewellery company Lily Blanche (lilyblanche.com)  and chair of the British Association of Women Entrepreneurs (Scotland). 

Today in the Times, she has this:

Toxic Work Culture in the NHS is a matter of life and death

Her argument is that toxic work environments in NHS Scotland are leading to worse care and thus unnecessary deaths, and that competition in healthcare will push standards up and, presumably, remove these. That she imagines the private sector less likely to experience bullying than the state sector is, in itself, bizarre.

The evidence she offers is utterly inadequate for her claims and I’m not going respond to each individually but, rather, I need only the extensive University of Oxford research review of 13 studies which unambiguously demonstrate that privatised health care strategies lead to ‘worse patient care.’

From Oxford University researchers reported in The Lancet, on 29 February 2024:

A new review has concluded that hospitals that are privatised typically deliver worse quality care after converting from public ownership. The study, led by University of Oxford researchers, has been published in The Lancet Public Health. The researchers carried out a meta-analysis based on evidence from 13 longitudinal studies, covering a range of high-income countries.* Each study assessed quality of healthcare measures for patients before and after health service privatisation, at either the hospital or regional level. The studies included measured indicators of care quality which included staffing levels, patient mix by insurance type, the number of services provided, workload for doctors, and health outcomes for patients such as avoidable hospitalisations.

Key findings:

• Increases in privatisation generally corresponded with worse quality of care, with no studies included in the review finding unequivocally positive effects on health outcomes.
• Hospitals converting from public to private ownership status tended to make higher profits. This was mainly achieved by reducing staff levels and reducing the proportion of patients with limited health insurance coverage.
• Privatisation generally corresponded with fewer cleaning staff employed per patient, and higher rates of patient infections.
• In some studies, higher levels of hospital privatisation corresponded with higher rates of avoidable deaths.
• However, in some cases (e.g. Croatia), privatisation led to some benefits for patient access, through more precise appointments and new means of care delivery, such as out-of-hours telephone calls.

According to the researchers, the results challenge the theory that privatisation can improve the quality of healthcare through increased market competition, and by enabling a more flexible and patient-centred approach.

https://www.ox.ac.uk/news/2024-02-29-new-study-links-hospital-privatisation-worse-patient-care#:~:text=A%20new%20review%20has%20concluded,in%20The%20Lancet%20Public%20Health.

Watch a report here:

Footnote – In case it’s not obvious, this is very high quality rigorous independent research. You can trust them.