'Hospital mergers increase death and harm'? Not so fast…
November 2019

Key points
- In February 2019 the Competition and Markets Authority (CMA) published a working paper on the impact of hospital competition on rates of patient harm in the English NHS
- We examine the central conclusion of the CMA paper – that the research provides ‘further empirical evidence that competition ultimately benefits patients’ – finding that this cannot be substantiated from the analysis
- We outline how more rigorous well-designed research is needed to measure the impact of competition on the quality of care
Encouraging competition for clinical care as a means to improve performance in the NHS has been a major feature of policy over the past 30 years. The policy is contentious and hotly debated, yet might have benefits. Good empirical evidence on the impact of competition in the NHS is crucial to guide future policy, and for national bodies such as the Competition and Markets Authority (CMA) to regulate effectively. Informed and evidence-based coverage of findings reported in the press on the NHS’s competition strategy is also critical.
In February 2019 the CMA published a working paper on the impact of hospital competition on rates of patient harm in the English NHS entitled Does hospital competition reduce rates of patient harm in the English NHS?
In this paper we first look in more detail at the CMA working paper to examine whether the claim that it provides ‘further empirical evidence that competition ultimately benefits patients’ can be made with any confidence. We conclude it cannot.Secondly we outline how further investigation might be improved in future. We do this by examining the approach taken in the CMA working paper, which is an approach shared across many similar studies on this topic.
Cite this publication
Further reading
Briefing
The measurement maze
Our briefing suggests there's potential to make better use of quality measurement to improve quality...
Collection
General Election 2019
Our views and analysis on health and social care from the 2019 General Election.
You might also like...
Press release
Plan for Digital Health and Social Care contains important ambitions, but tackling workforce and capacity pressures will be the key to realising the vision
Health Foundation response to the publication of the government’s Plan for Digital Health and Social...
Event
Webinar: What should the COVID-19 inquiry focus on?
In this webinar, we looked at the key questions for the inquiry and explore ways in which it could...
Event
Webinar: What does the future look like for the general practice workforce?
In this webinar, we will explore the REAL Centre’s upcoming report on updated NHS workforce supply...
Get social
Health Foundation @HealthFdn
Better use of tech and data offers significant potential to drive faster improvement in health and care. Will the G… https://t.co/y10GKFdvaU
Follow us on TwitterWork with us
We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.
View current vacanciesThe Q community
Q is an initiative connecting people with improvement expertise across the UK.
Find out more