NHS bosses are pursuing anti-competitive practices often for no valid reason, an official review says.
The investigation by the independent Co-operation and Competition Panel for the government highlighted a range of tactics it had concerns about.
These included block contracts and restrictions which often favour local hospitals ahead of the private sector and other parts of the NHS.
It comes as the government is extending the role of competition in health.
Earlier this month ministers said community services, including podiatry and counselling, should be opened up to greater competition so that patients could choose between NHS, private and voluntary sector providers.
‘Blocking choice’This was done for non-emergency hospital operations, such as knee and hip surgery, five years ago.
About 200,000 of the five million procedures done each year are now performed by private hospitals approved to do NHS work.
Patients have also used choice to opt to be treated in hospitals outside their local areas. This is sometimes done so they can be close to family members while being treated or because they believe they can get better care elsewhere.
The Co-operation and Competition Panel (CCP) has been looking at this area of the health service.
They received evidence that nearly half of the 151 local management bodies known as primary care trusts (PCTs) were blocking choice.
In particular, they highlighted a series of measures which were being taken:
- Block contracts – These guarantee certain hospitals a set number of patients, leaving the private sector and other providers only what is left over.
- Management referral centres – These vet GP referrals, allowing patients to be channelled to favoured providers.
- Minimum waiting times – Insisting patients wait a certain length of time before treatment. Private firms say this is about lowering the bar so that they cannot use the pulling power of quicker care.
- Activity caps – Limits on the number of patients that can be referred to certain providers.
- Fewer options – Reducing the range of treatments a provider can offer patients. Hospitals whether in the private sector or NHS only get paid if a PCT will release the funds.
PCTs had argued they needed to do this for a combination of reasons, including balancing the budget and protecting the future of their local hospitals.
But the report rejected this, saying in many cases there was unlikely to be valid reasons for such moves.
It also accused managers of a lack of transparency about the decisions and warned them they were leaving themselves open to formal challenge.
However, the panel did not go as far as to suggest there should be a complete ban on the practices.
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