Provider diversity in the English NHS: a study of recent developments in four local health economies

Article English OPEN
Allen, Pauline ; Turner, Simon ; Bartlett, Will ; Perotin, Virginie ; Matchaya, Greenwell ; Zamora, Bernarda (2012)
  • Publisher: Royal Society of Medicine Press
  • Related identifiers: doi: 10.1258/jhsrp.2011.011015
  • Subject:
    mesheuropmc: health care economics and organizations

Objectives: The overall objective of the research was to assess the impact of provider diversity on quality\ud and innovation in the English NHS. The aims were to map the extent of diverse provider activity, identify\ud the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises,\ud and incumbent organisations within the NHS, and the factors that affect the entry and growth of new\ud private and TSOs.\ud Methods: Case studies of four Local Health Economies (LHEs). Data included: semi-structured\ud interviews with 48 managerial and clinical staff from NHS organizations and providers from the private\ud and Third Sector; some documentary evidence; a focus group with service users; and routine data from\ud the Care Quality Commission and Companies House. Data collection was mainly between November\ud 2008 and November 2009.\ud Results: Involvement of diverse providers in the NHS is limited. Commissioners’ local strategies\ud influence degrees of diversity. Barriers to the entry for TSOs include lack of economies of scale in the\ud bidding process. Private providers have greater concern to improve patient pathways and patient\ud experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater\ud degree of community involvement. Entry of new providers drives NHS Trusts to respond by making\ud improvements. Information sharing diminishes as competition intensifies.\ud Conclusions: There is scope to increase the participation of diverse providers in the NHS, but care must\ud be taken not to damage public accountability, overall productivity, equity and NHS providers (especially\ud acute hospitals, which are likely to remain in the NHS) in the process.
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