Research which claims to show that the introduction of patient choice in the NHS reduced deaths from heart attacks is flawed and misleading, according to a report* published in The Lancet today (Monday).
The original study was used by the Government to advance its controversial Health and Social Care Bill 2011 and was the basis for the Prime Minister's statement that 'competition is one way we can make things work better for patients'.
In today's report, academics - led by Professor Allyson Pollock of Queen Mary, University of London - point out a series of errors in the study and conclude that it is 'fundamentally flawed'.
The research David Cameron referred to was a paper by Zack Cooper and colleagues which was published by LSE Health. It examined the mortality rates for heart attack patients measured against the number of hospitals within travelling distance of the patient's GP surgery. It also looked at data on elective surgery for hernia, cataract repair, knee arthroscopy, hip replacement and knee replacement, and claims to show that introducing greater choice in elective surgery led to lower death rates from heart attacks.
Professor Pollock and her colleagues - including Professor Alison Macfarlane at City University London - say that, crucially, the study offers no explanation as to why the availability of choice for such elective procedures should have any effect on whether heart attack patients survive.
The Lancet report also points out the following:
- the researchers do not look at whether the availability of choice has any effect on where patients go for treatment,
- they do not look at whether or how GPs' patterns of referrals changed when choice became available,
- recent research indicates the majority of patients who have been offered a choice pick their nearest hospital,
- heart attack is a medical emergency and patients generally have no choice about where they are treated,
- outcomes for heart attack patients tend to be better when they are treated in specialist centres in urban areas,
- the authors ignore the possible effects of major changes in primary care prevention and secondary care intervention for heart attacks,
- and that there is no evidence that the data on elective operations is in any way a good measure of choice or competition.
Professor Pollock said: "The Government's Health Bill has faced enormous opposition from the public and from health professionals. In trying to win over his critics the Prime Minister has used the study by Zack Cooper to justify competition within the National Health Service.
"Our examination of this research reveals it to be fundamentally flawed, amounting to the conclusion that the paper simply doesn't prove either cause or effect between patient choice and death rates.
"This work should not be quoted as scientific evidence to support choice, competition or the new Health and Social Care Bill."
Note to editors
* 'Statistical association is not causation: Claims that patient choice and market competition in the NHS reduce AMI mortality are misleading and false', Pollock, A, et al, Lancet Online First publication, 10 October 2011
Queen Mary, University of London is one of the UK's leading research-focused higher education institutions with some 16,000 undergraduate and postgraduate students. Amongst the largest of the colleges of the University of London, Queen Mary's 3,000 staff deliver world-class degree programmes and research across three faculties: Science and Engineering; Humanities and Social Sciences and the School of Medicine and Dentistry.
One of the rising stars in UK higher education, Queen Mary was ranked 11th nationally in the last Research Assessment Exercise, and was rated as one of the world's elite universities in the 2010 Times Higher Education's Top 200 World University Rankings (120th place).
The College has a strong international reputation with around 23 per cent of students coming from over 130 countries. Queen Mary has an annual turnover of £300m, research income worth £70m, and a yearly impact on the UK economy of over £750m.
Queen Mary, as a member of the 1994 Group of research-focused universities, has made a strategic commitment to the highest quality of research, but also to the best possible educational, cultural and social experience for its students. The College is unique among London's universities in being able to offer a completely integrated residential campus, with a 2,000-bed award-winning Student Village on its Mile End campus.
City University London is an international University with a commitment to academic excellence, a focus on business and the professions and a central London location. It is placed in the top 5% of universities around the world by the Times Higher Education World University Rankings 2010-11 and is ranked in the top 30 UK higher education institutions by the Times Higher Education Tables of Tables 2011.
The University's Student Centre holds the 2011 Times Higher Education Leadership & Management Award for Outstanding Student Services Team.
City is a broadly-based University with world leading strengths in business; law; engineering and mathematical sciences; informatics; health sciences and the arts including journalism and music.
The University attracts over 21,000 students from more than 160 countries and academic and professional staff from over 50 countries.
City University London's predecessor, the Northampton Institute, was founded in 1894. City will celebrate its first half century as a University in 2016.
www.city.ac.uk
Journal
The Lancet