DSPI leads study revealing health outsourcing linked to higher mortality rate

Hospital corridor

Treatable mortality is linked to an increase in outsourcing of health services to the private for-profit sector, according to a new study by Department of Social Policy and Intervention researchers published today (30 June) in the Lancet Public Health.

Led by DPhil student Benjamin Goodair and Dr Aaron Reeves, Associate Professor of Evidence-Based Social Intervention and Policy Evaluation, the study found, since 2014, out-sourcing has been associated with an additional 557 deaths across 173 of England’s clinical commissioning groups. 

According to the peer-reviewed study, out-sourcing to for-profit companies consistently increased between 2013 and 2020, corresponding ‘with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services’.

Benjamin Goodair said: ‘This new study represents the first attempts to measure the total impact of for-profit outsourcing from England’s NHS on health outcomes.

'While the analysis is not able to identify a causal relationship, the results suggest that the privatisation of healthcare is corresponding with worse quality care.

‘These findings are particularly timely as the NHS is currently going through a structural transformation, adding new evidence to suggest that for-profit provision of healthcare services may not be the best option for the new commissioning bodies.

‘The strength of this research lies in its novel dataset, produced by Dr Charles Rahal, of the Department of Sociology, and colleagues, it gives us an ability to analyse, at a very granular level, hundreds of millions of pounds worth of expenditures from NHS organisations.’

Justified concerns

He continues, ‘At the turn of the decade, health campaigners were fearful that the 2012 Health and Social Care Act would increase the level of for-profit outsourcing, reducing the quality of care received by NHS patients. This study finds that their concerns may well have been justified.’

The Oxford researchers studied expenditure data from NHS commissioning groups and supplemented the data with rates of local mortality from causes that ‘should have been treatable by medical intervention’.

Outsourcing to for-profit providers has increased considerably since 2013, and by 2020 accounted for more than 6% of total reported expenditure: some £323 million went to such companies in the first quarter of 2020. The report states, ‘Since the reforms to the NHS in England in 2012, some measures of health-care quality, as well as population health, have been worsening’.


Dr Reeves added: ‘Troublingly, there has been very little improvement in life expectancy since 2010 and many have argued that austerity has contributed to this stagnation in population health. Alongside this, we suggest that outsourcing to for-profit companies is another way that the reforms of the post-financial crisis era have affected NHS service quality and mortality rates.’

The authors acknowledge that marketisation of health-care services is underpinned by the belief that openness, competition, and management autonomy can improve the efficiency and performance of state-funded services. But, they say, ‘Our results suggest that these processes…are not associated with improvements in service provision, and instead have been associated with increased deaths among patients.’

According to the study, outsourcing could lead to increased mortality in two ways:

  • Private providers could be ‘delivering worse quality care’…although recent evidence finds no difference in death rates from surgeries in private settings; or
  • Outsourcing leads to intensified pressure across the health system.

The study concludes: ‘Our research raises doubts about whether the current extent of private sector use is optimal for the quality of care and suggests that further increases in for-profit provision would be a mistake.’