Outsourcing NHS services to the private sector is associated with reduced quality of patient care and increased rates of deaths from treatable causes, according to an analysis published in The Lancet Public Health journal.

Findings from the study suggest increased privatisation of health services in England between 2013 and 2020 was linked to higher rates of treatable mortality – deaths considered avoidable with timely, effective healthcare – indicating a decline in the quality of healthcare over the period.

The study is the first comprehensive assessment of health service privatisation in England conducted since the introduction of reforms in 2012 encouraging greater outsourcing. The effects of the Health and Social Care Act on healthcare quality have been contested. Since it was introduced, worsening trends have been observed for some indicators of healthcare quality, including treatable mortality rates. [1] However, a lack of data suitable for analysis meant no studies until now had investigated links between outsourcing at regional health board level and health outcomes.
"The unparalleled data utilised in this study enabled us to conduct the first rigorous analysis of one the most controversial health care reforms in England's recent history. While some have argued the Health and Social Care Act would improve the performance of health services by increasing competition, our findings add merit to long-standing concerns it could instead lead to cost-cutting and poorer health outcomes ." says study author Benjamin Goodair of the University of Oxford [2]

The authors analysed a new data set showing how much each regional health board spent on outsourcing between 2013 and 2020. Changes to the quality of health services were determined using a statistical analysis to investigate associations between outsourcing and treatable mortality, a key measure of the effectiveness of timely healthcare interventions [3]. Further analysis looked for any association between outsourcing and preventable mortality – deaths mainly avoidable with effective public health, not medical interventions – which is not regarded as a measure of healthcare quality.

The data contains more than 12,700 files containing details of outsourcing expenditure from regional health board websites. This yielded data on over £204 billion of expenditure – comprised of more than 645,000 individual payments – for 173 of England's 191 (as of 2019) regional health boards between April 2013 and February 2020 [4].

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