Why we need better information on private healthcare to save the NHS

pexels-photo-302083.jpegMy last article for this journal looked at the role of the market and competition in the NHS in the UK. It concluded that, without access to accurate, unbiased and up to date information, patients cannot make effective decisions about their healthcare and the market cannot work. The NHS has made good progress in improving information available to patients through NHS Choices although further improvement is needed to realise the benefits of a market in the NHS.

Private healthcare has existed in parallel to the NHS since the NHS came into effect in 1946. Perhaps, therefore, the NHS can learn from the private sector about creating an effective market based on high quality information. However, it would appear that this is not the case.

Intuitively, you would assume that there is a wealth of comparative information available to patients on the quality (and cost) of private healthcare. However, this has not traditionally been the case. In 2014, the Competition and Markets Authority undertook an inquiry into the private healthcare market which resulted in the Private Healthcare Market Investigation Order 2014. The investigation found that there was not the same volume and quality of information available about private healthcare as there was about the NHS. Consequently, the Authority made the “Private Healthcare Market Investigation Order” which requires private healthcare providers to submit information to the Private Healthcare Information Network (PHIN) on quality information, such as infection rates, and will eventually extend to information on cost. In May 2017, the PHIN published 3 performance measures covering 149 procedures at over 200 hospitals (https://www.phin.org.uk/home). Whilst the Nursing Times described this as a “significant step” this is still only 3 performance measures which represents a lot less information than is currently available about NHS provided services. Information on cost is even more difficult to find, although this does exist with http://www.privatehealth.co.uk and bestcarecompare.com leading the way.

So, there is not a great deal of information available about private healthcare quality and cost. So what? Common estimates suggest that only 8% to 12% of the population use private healthcare, so what has this got to do with the NHS?

Firstly, if there is no comparative information available to patients then market forces can not improve quality and lower cost. If effective price competition existed then prices would become lower. If prices were lower, then more patients, who currently use the NHS, would use private healthcare. This would cost the NHS less and would reduce waiting times for patients still using NHS services.

Secondly, the NHS is having to make very difficult decisions about rationing services. A lot of services are being deemed as not clinically effective and more and more patients are being turned away from the NHS for basic diagnostic tests. Providing lower cost private healthcare, by encouraging market forces, will make these tests and procedures available to a larger number of patients. More importantly, making private healthcare more affordable will reduce the financial pressure on the NHS which will reduce the need for further rationing in the future.

The NHS is becoming increasingly unaffordable. Limited information about private healthcare cost and quality allows private providers to charge more than market forces would dictate. By improving the quality of comparative information available to patients, costs can be lowered and more patients will choose to use private healthcare. This will free up resources for the NHS and will lead to lower

waiting times and reduced rationing. Hopefully organisations such as The Private Healthcare Information Network and  bestcarecompare.com will make this a reality.

Mike Williams is Director of Analytics at iCaps Health Ltd

Listening to Patients via Social Media

twitter-facebook-together-exchange-of-information-147413.jpegThe first time I was referred to hospital by a GP, the information I had available to me on the suspected diagnosis and the options available to me was practically non-existent. Due to the absence of any better information, I remember looking up the terms that the GP had used in a dictionary. This was only 20 years ago but it is easy to forget how far the information revolution has driven us in empowering patients and ultimately improving the quality of healthcare. When I was referred in the late 1990’s, I didn’t have a choice of hospital to go to, waiting times were excessive and outcomes were nowhere near as good as they are now. The monumental improvements that have been made are obviously partially due to the additional cash that was injected into the NHS following the publication of the NHS Plan. However, this is also partially due to the information revolution which has led to the empowerment of patients and has provided information on how to stay healthy as well as providing a choice to patients when it comes to their healthcare. It is too easy to forget how much the NHS has improved over the last 20 years and we should congratulate all the staff in the NHS for making this happen. However, the internet has also played a role in facilitating some of these improvements. We are lucky to have http://www.nhs.uk to provide peer reviewed, validated information and data on healthcare services. We also have sites such as www.bestcarecompare.com (The “Trip Advisor” for healthcare) to provide information to support choices about where to receive treatment. However, in this article I want to focus on the role of social media and, in particular, the role of Twitter in the NHS.

@NHSCHoices has 218,000 followers and regularly tweets on health issues and ways to improve your health as well as sign posting people to more detailed information on http://www.nhs.uk. Most hospitals/NHS Trusts have twitter accounts. Bart’s Health, for example, has nearly 10,000 followers and regularly tweets about some of the great things they are doing. Most CCGs also have Twitter accounts and tweet about local services and service redesign amongst other things. There is therefore no shortage of validated and official information on Twitter. However, there are 2 main points I want to make in relation to Twitter.

Firstly, Twitter provides a platform for users to provide information and comment which is incorrect, misleading and potentially dangerous. Given that Twitter has more than 330 million users each month it is difficult to police all these comments. Twitter is great in the speed and extent to which it can disseminate information. However, when this information is misleading or incorrect this can be very negative. For example, @Homeopathyinfo has nearly 10,000 followers. In May 2017, it was reported on social media that North Devon Healthcare NHS Trust were closing the maternity and emergency departments at North Devon District Hospital. According to reports, this information was widely shared on social media and was incorrect. In this instance, the Trust identified the issue and responded accordingly. However, given the 330 million Twitter users, it is difficult to police comments made about you and your organisation.

The second point I wanted to make is that Twitter is used by the NHS as a communication tool. For me, communication is about talking and listening. Unfortunately, whilst Twitter provides the NHS with the means to talk about health and healthcare, it is not as easy to listen to what patients and the public are saying about the services. This is partially because not all comments use the appropriate hash tags and @mentions but also because the volume of comments about the NHS is much greater than the number of comments being made by the NHS. The NHS desperately needs to listen to what patients are saying and Twitter provides a great opportunity to do this.

Mike Williams is Director of Analytics at iCaps Health Ltd

Patient Choice and the Death of the NHS Internal Market

pexels-photo-263402.jpegIn 1989 the white paper “Working for Patients” paved the way for the creation of the “internal market” in the NHS. Since then we have seen GP fundholding, the creation of Primary Care Groups/Trusts and the development of a payment system that funds hospitals based on the number of patients they see. The ongoing re-structuring and policy changes that have occurred since 1989 have left us with an internal market where Clinical Commissioning Groups (CCGs) purchase health care services from providers, including hospital trusts.

The theory of the internal market is very simple and assumes that market conditions will provide “consumers” with choice which will force “providers” to increase quality and lower cost or go out of business. It works in many industries, so has it worked in the NHS?

This is obviously a very difficult question to answer due to the many factors that influence the quality of healthcare (most notably the level of funding). Furthermore, it is very difficult to measure quality within the NHS. Consumer satisfaction (e.g. the friends and family test) is not a good measure of quality. From a financial perspective, it is slightly easier to weigh the transaction costs associated with an internal market against any efficiency savings that have been seen. However, I will not attempt to do this in this article, and will refer readers to numerous articles, written by the Nuffield Trust, the King’s Fund and other think tanks/academic organisations, on this subject.

What is clear is that NHS England has a choice itself. It can either scrap the internal market, and use the transaction costs to fund front line services, or improve the market to ensure that market forces lead to the desired outcomes. With the creation of Accountable Care Organisations and the development of Sustainability and Transformation Plans (STPs), the direction of travel looks clear. However, it is unlikely that the internal market will be completely dismantled. It is, therefore, worth looking at some of the practical barriers that have prevented the internal market achieving the improvements that the theory suggests it could make.

The biggest barrier to the success of the internal market has been the failure to give patients real choice. There are a number of reasons for this, but firstly let’s dispel some common myths about patient choice in the NHS.

1. “Patients do not want choice” – It is often said that patients want their local hospital to be fit for purpose and do not want to travel elsewhere for treatment. There is some truth in this, but as an increasing number of consumers are changing energy supplier, choosing different care homes and insurance suppliers, it is only a matter of time before patients will demand to be able to choose the best hospital for their treatment. After all, they have a legal right to do so.

2. “Choice cannot exist without spare capacity” – I am amazed how often I hear colleagues in the NHS make this statement. One of the most important issues for patients who need secondary care is waiting times. We know that demand often exceeds supply within the NHS but, if there are 2 queues and one is shorter than the other, I know which one I would choose.

So what is the real reason that patient choice has not delivered? Quite simply there is not enough accurate, high quality information available for patients to make informed choices. The website

“NHS Choices” provides limited information, but it does not provide the information that I would want when deciding where to have a hip operation. If I need a hip operation, I want to know

1. What will the clinical quality be like?

2. How long will I have to wait (for my specific procedure)?

NHS Choices provides the latest CQC rating (which is not specific to my procedure) and also the proportion of patients that were seen within 18 weeks (again not specific to my procedure). However, if I want to compare having my operation at different hospitals, this is not enough information. I want to know the average waiting time for the procedure that I am going to have. This information is available to the NHS and is provided in tools such as the iCaps Patient Pathways Tool. However, this information is not routinely available to patients. This may change in early 2017 when this information will be available on http://www.bestcarecompare.com

NHS Choices does provide a vast array of information, including the percentage of registered nurse day hours filled as planned. However, this is not really the information that I need in order to make an informed choice.

The NHS has a choice – either get rid of the internal market and associated transaction costs or provide patients with the information required to make the internal market a reality. As consumers continue to exercise their right to choose in other services, it is only a matter of time before they start to exercise their legal right to choose their healthcare provider. However, we need detailed and specific information to inform these choices.

Mike Williams is Director of Analytics at iCaps Health Ltd