NHS Competition Harming Evolution Of Specialist Cancer Treatment Centres

18 November 2013

NHS Competition Harming Evolution Of Specialist Cancer Treatment Centres

The health regulator Monitor is investigating whether competition related changes to hospitals-designed to improve choice and access for patients-are actually contravening governmental regulations.

The government initially wanted to introduce greater competition into the NHS, but the means by which they are attempting to do this have had the opposite effect of actually stifling the creation and development of revolutionary cancer treatment centres.

Investigations by Monitor reveal that certain hospitals whose roles would be downgraded under proposed changes are blocking moves to concentrate cancer services into fewer high-performing specialist centres, by alleging that such mergers would be anti-competitive and would reduce patient choice.

Top leaders within the NHS are concerned about the impact of such legal disputes, especially since they seem to be harming the actual provision of care to patients. This is particularly so with cancer units where it seems that they are being allowed to carry on operating even though they do not meet the latest official guidelines on how services should be organised for maximum effect.

Former Tory health secretary Stephen Dorrell chairs the all-party select committee on health has called on NHS to ensure these improvements are driven home making it abundantly clear that patient care and patients’ lives were paramount and should be the top concern.  

The outgoing chief executive of NHS England, Sir David Nicholson spoke to told Dorrell's select committee a week and a half ago and maintained that "we are in my view getting bogged down in a morass of competition law, which is causing significant cost in the system".

"It is causing great frustration for people in the service about making change happen. That may be because of the way in which we are interpreting the law – we are talking to Monitor – but it may be because that is the law, in which case to make integration happen we will need to change it."

Dorrell said to the Observer that the interests of patients were an absolute priority. "I am in favour of engagement with local clinicians and management, and it is obviously better to proceed by agreement. If however, as is the case in cancer care, there is well-documented evidence from all over the world that more concentrated facilities deliver better patient outcomes, it is the duty of the commissioner to insist that services change to improve outcomes for patients. Local motivation and engagement are important, but they are not more important than patients' lives."

Another Tory member of the committee, Sarah Wollaston, opined: "It is utterly perverse for any doctor to use competition legislation to try to block restrictions on their own practice where there is clear evidence that cancer surgery concentrated in specialist centres saves lives. David Nicholson should set out where this is happening and what needs to change in the legislation."

As the government attempts to deal with the pending crisis of rising waiting times and overcrowded A&E departments, these reforms may be argued to be only increasing more competition and bureaucracy as opposed to dealing with patient care first and foremost.

A spokesman for NHS England said that in order to comply with official guidance from the National Institute for Health and Care Excellence, "some cancer treatment needs to be concentrated into a smaller number of providers, where clinical expertise can be consolidated".

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