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Government claim that patient choice improves healthcare is based on flawed research, City expert says

City academic features in The Lancet
by Hollie Jenkins

Research which claims to show that the introduction of patient choice in the NHS reduced deaths from heart attacks is flawed and misleading, according to a report* published in The Lancet on Monday 10 October 2011.

The original study was used by the Government to advance its controversial Health and Social Care Bill 2011 and was the basis for the Prime Minister's statement that 'competition is one way we can make things work better for patients'.

In The Lancet academics, led by Professor Allyson Pollock of Queen Mary, University of London in collaboration with Professor Alison Macfarlane from City University London, point out a series of errors in the study and conclude that it is 'fundamentally flawed'.

The research David Cameron referred to was a paper by Zack Cooper and colleagues which was published by LSE Health. It examined the mortality rates for heart attack patients measured against the number of hospitals within travelling distance of the patient's GP surgery. It also looked at data on elective surgery for hernia, cataract repair, knee arthroscopy, hip replacement and knee replacement, and claims to show that introducing greater choice in elective surgery led to lower death rates from heart attacks.

Allyson Pollock, Alison Macfarlane and their colleagues say that, crucially, the study offered no explanation as to why the availability of choice for such elective procedures should have any effect on whether heart attack patients survive.

The Lancet report also points out the following:

  • Zack Cooper and his colleagues did do not look at whether the availability of choice has any effect on where patients go for treatment they did not look at whether or how GPs' patterns of referrals changed when choice became available
  • Other recent research indicates the majority of patients who have been offered a choice pick their nearest hospital
  • Heart attack is a medical emergency and patients generally have no choice about where they are treated
  • Outcomes for heart attack patients tend to be better when they are treated in specialist centres in urban areas
  • The authors ignored the possible effects of major changes in primary care prevention and secondary care intervention for heart attacks
  • There is no evidence that the data on elective operations is in any way a good measure of choice or competition.

Professor Macfarlane from City University London said:

"The authors of this article attributed the fall in heart disease mortality in recent years to the patient choice policies introduced over the same time period.

"They gave no plausible explanation of any reason for assuming the relationship was due to cause or effect. At a time when there is increasing concern about the need for healthcare policies to be supported by good evidence, this flawed research does not justify the wholesale changes to the NHS set out in the NHS Health and Social Care Bill."

*No evidence that patient choice in the NHS saves lives, Pollock, A, et al, Lancet Online First publication, 10 October 2011

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