Broken Promises The impact of outsourcing on NHS services

Jane Lethbridge
Apr 2012

Advocates of outsourcing NHS services to the private sector often make sweeping claims about the benefits of privatisation on the care received by patients. This project has identified a range of studies that have examined some aspects of outsourcing in the NHS and the effect on patient care. It is noticeable that much of the evidence demonstrates either the negative aspects of introducing competition into the provision of health care services or inconclusive results. A lack of data makes it difficult to assess the impact of contracted out services on accessibility of services and health outcomes. Overall, there is a lack of evidence to show that outsourcing leads to improved quality of patient care. The experience of outsourcing cleaning services shows that there was a negative impact on patient care. Outsourcing of clinical services through ISTCs and GPs ‘out of hours’ services shows some negative effects on patient care, poor value for money as well as evidence of inadequate monitoring and evaluation of the services. Although there is some evidence of the benefits of shared services, the experience of the NHS IT project was a clear failure of outsourcing.

The introduction of outsourcing to the NHS has identified the need for data collected to measure the quality of patient care after the contracting process. At the moment, a combination of academic research, research from regulatory agencies and trade union research provide the most effective way of gathering evidence of the impact of outsourcing into the quality of patient care. Many of these studies do not show any demonstrable benefits from outsourcing. Other academic studies have assessed the impact of competition on the NHS in a limited way, either using one service, or one health outcome. The conclusions are then applied to the whole of the NHS, as a way of justifying more competition. This research needs to be challenged because it is being used to justify continued competition and marketisation policies in the NHS.