Civitas publishes the findings of a year-long study into the effectiveness of the market in the NHS: whether and why it has driven the performance of providers as was intended; and what should be done to make it work better going forwards.

A summary can be found here and commentaries from high-profile figures including former Labour Health Minister, Lord Warner, and former Executive Chair of Monitor, Dr Bill Moyes, here.

The impact of the NHS market: An overview of the literature
- Laura Brereton and Vilashiny Vasoodaven, 1 March 2010

The NHS has operated on the basis of a market since 2002, with a split between purchasers and providers of health care. In the first comprehensive review of the evidence thus far, the authors show market forces have contributed to: improved access for patients; reduced waiting times and increased efficiency; and improved financial management in providers. However, benefits are not widespread. The NHS appears to be in the unfortunate position of taking on the extra costs of competition without realising the benefits.

Markets in health care: the theory behind the policy
- James Gubb, Oliver Meller-Herbert, 18 December 2009

In its current state, the NHS functions on the basis of what has been variously called a quasi, mimic or internal market, where providers - NHS, voluntary and private - are theoretically competing and placed on an even footing. With debate around this principle intensifying, this paper revisits the anticipated benefits of the use of market mechanisms; asks on what theory they rest; and where the NHS currently stands.

Putting Patients Last: How the NHS keeps the ten commandments of business failure
- Peter Davies, James Gubb, 30 July 2009

In recent years, NHS reform in England has focused on stimulating competition between providers and increasing choice for patients. Many NHS organisations are now as much businesses as they are public bodies; if they fail to design services around patients and meet their needs, they should start to lose custom as well as incurring the wrath of government. But just how good are they at satisfying their 'customers' - the patients? We use a framework developed by Donald R. Keough, former president and CEO of the Coca-Cola Company, to assess this.

Failing to Figure: Whitehall's costly neglect of statistical reasonsing
- Mervyn Stone, 15 June 2009

As the size and scope of government grows, so do the resources allocated to public services. But how do we know that allocations are fair or reasonable? In "Failing to Figure" Mervyn Stone examines the process, including the allocation of funds to Primary Care Trusts, and finds it lacking in transparency, and even common sense.

Checking-Up on Doctors: A Review of the Quality and Outcomes Framework for General Practitioners
- James Gubb and Grace Li, 19 November 2008

The Quality and Outcomes Framework (QOF) links up to a third of general practice income to achievement against a series of quality indicators. While it has delivered benefits in the treatment of conditions included, the net benefit is unclear. There is evidence that the financial incentive is diverting attention away from other conditions and harming the relationship between GPs and patients.

Why the NHS is the sick man of Europe
- James Gubb, 12 March 2008

With political interference in the NHS showing no sign of abating, there is a case for considering more radical options than those under review by Lord Darzi: to look to Europe for less centralised ways of providing universal and comprehensive health care. The recent reforms in the Netherlands provide a particularly interesting case.

Quite like heaven? Options for the NHS in a consumer age
- Nick Seddon, 28 November 2007

Described in a foreword by the former President of the Royal College of Surgeons of England, Bernard Ribeiro, as 'an excellent analysis', Seddon argues it is out respect for the very founding principles of the NHS - universal and comprehensive care - that it must embrace its consumers and open up to real choice and competition to turn it once more into a source of pride.

Commissioning London’s HIV Services
- Rosalind Miller, James Gubb, 2 September 2011

The number of people living with HIV in the UK is estimated to be 86,500, representing a threefold increase over the past decade. Over half of all cases are in London. This report focuses on the commissioning of HIV services in London, documenting the findings of semi-structured interviews conducted with key stakeholders in late 2010. It carries particular relevance given the intention of government to transfer commissioning responsibility from Primary Care Trusts to clinical commissioning groups.

Gordon Brown's former head of public service transformation discusses the risks associated with the Government's proposed overhaul of commissioning in the NHS White Paper.

An in-depth analysis questions the proposed abolition of all Primary Care Trusts by 2013, in favour of GP 'consortia'. A more incremental approach is advocated, permitting reform on a 'human' rather than 'utopian' scale.

It is likely that GP consortia will cover smaller populations than existing PCTs. Analysis of international trends in the size of commissioning organisations and of past performance of PCTs shows there is little if any theoretical or empirical evidence to suggest a move to smaller commissioning organisations will lead to better commissioning or patient care.

NHS White Paper: Transferring commissioning responsibility from PCTs to GPs
- James Gubb, 10 July 2010

The financial risk posed by the government's plans to transfer commissioning responsibility from PCTs to GPs is substantial and puts the £ 20bn efficiency savings the NHS is required to make in jeopardy. The last restructuring of commissioning, the merging of PCTs in 2006, caused an absolute drop in performance of at least a year. It took three years for the performance of those that were merged to catch up with those that were not.

Pre-election briefing on health care and the NHS
- James Gubb, April/May 2010

A glance at the current state of the NHS; Labour's achievements over the past decade; and what the political parties are proposing for the NHS.

Formulas at war over two sorts of inequality in health funding
- Professor Mervyn Stone, April 2010

This online briefing looks at the funding formula for primary care trusts (PCTs) - geographic entities that are charged with commissioning (buying) health care in the NHS - and the its weighting for health inequalities, in particular. It argues that the formula is based on 'unscientific formula mongering' and has resulted in a number of PCTs losing out on valuable resources to the tune of millions of pounds.

BMA campaign to shut out independent sector from NHS is misguided and foolhardy
- James Gubb, 12 February 2010

The BMA have extended their 'Look After Our NHS' campaign, to stop commercially run firms providing NHS care and end the market in the NHS, to patients. However, their campaign is too often based on cherry-picked evidence and appears out of touch with public opinion.

President Obama should look to Europe, not the NHS
- James Gubb, 14 August 2009

The NHS has been caught up in a media storm around the US health care debate. This briefing calls for a bit more realism, a bit less propaganda. The NHS is neither 'evil' nor the 'envy of the world'. Evidence suggests European health systems perform better than both the NHS and the US; and that President Obama would do well to look across the channel to find better models for providing universal health insurance.

Why are we waiting? An analysis of waiting times in the NHS
- James Gubb, 2 January 2008

The government have vested much political capital in the 18-week referral to treatment target, but is it really achievable and at what cost? A less distorting approach would be to remove the target and use the framework, already in place, for choice and competition to create a more self-sustaining means of improvement.

Just how well are we? A glance at avoidable mortality from cancer and circulatory disease in England & Wales
- James Gubb, 1 November 2007

Real improvements have been made, and performance has compared quite favourably with European countries of comparable development, but there are two particular causes for concern: a) the rate of improvement in avoidable cancer mortality has fallen since 1999, at odds with trends since 1979; b) avoidable mortality from circulatory disease remains very high.

Innovation needs competition
- James Gubb, October 2007

The recommendation of the interim report of Lord Darzi's Next Stage Review, that a Health Innovation Council be set up with a budget of with a budget of #100m 'to help the NHS develop and deploy hi-tech health care such as medical devices and diagnostics' is unlikely to produce tangible benefits until the NHS embraces competition and genuinely empowers patients.