Study finds private hip operation policy failed to boost rates
The practice of Scottish health boards contracting out hip operations to the private sector led to a decline in such procedures on the NHS, researchers say.
The team at Queen Mary University of London studied the impact of diverting NHS funds to private providers.
It had been hoped that contracting out operations to private firms could free up NHS surgeons and cut waiting lists.
The authors found the more contracts went to the private sector, the fewer operations the NHS did itself.
They also found that patients aged over 85 from deprived areas may have been disadvantaged by the Patient Choice policy launched in 2002.
The idea behind contracting out operations to the private sector was that it would free up space for the NHS to do others, reducing waiting times.
But the new study, published in the Journal of Public Health, found that the NHS actually got less operations done after contracting work out to the private sector.
Lead author Graham Kirkwood said: "The claim made by NHS Scotland's 2003 white paper that the additional use of the private sector would provide 'sustainable local solutions to long waits' for elective hip replacement is not supported by the evidence.
"The involvement of the private sector was supposed to provide extra capacity to tackle long waiting times - so in theory we should see NHS treatments stay at the same level or increase. Instead our results show the level of NHS treatments going down during a period of high private sector activity."
The researchers studied the period from 2006 to 2009, the time of highest private sector activity. The authors said this may have been due to the signing of the first block contract between the NHS and the private healthcare sector, worth £18.7m, in November 2006.
Even after the number of private sector operations dropped in 2009, in some areas - Fife, Grampian and Lothian - the number of NHS operations had not recovered by 2013.
The research also suggested that health policies had disadvantaged patients aged 85 and over in areas of high deprivation, with claims that private firms had chosen not to serve older and poorer patients.
The Patient Choice policy was introduced in 2002 to allow patients to choose between an out of area NHS provider or a private provider, funded by the NHS.
Over the next decade, the treatment rate for patients aged 75-79 increased by 65.7%, while the rate for patients aged 85 and over increased by a lesser 31.3%.
Treatment rates for the least deprived areas increased by 67.3%, while those in the most deprived areas increased by 47.7%.
Co-author Prof Allyson Pollock said these were "concerning" results.
She said: "The 2010 UK wide Equality Act legislated for public bodies such as the NHS to tackle inequalities in the delivery of care by a range of factors including age, sex and socio-economic deprivation.
"Our results are therefore concerning and complement other studies that have shown that the private sector is risk averse and more likely to select out healthier and less poor patients."