In brief
Against the backdrop of radical reform of the NHS and a public service reform White Paper due imminently, the first in our series of breakfast events offered a timely opportunity to discuss choice and competition in the context of wider public service reform.
Carol Propper, Professor of Economics, Imperial College Business School
Carol Propper talks about international perspectives on choice and competition in health care and outlines the potential for competition to deliver quality improvements in the NHS.
Anna Walker, Chair, Office of Rail Regulation Board
Anna Walker draws on her experience of the competition regime in the utilities sector to discuss what choice and competition can offer the NHS.
Stephen Dunn, Director of Strategy, NHS East of England
Dr Stephen Dunn explains how NHS East of England has used competition to drive up quality, outcomes and efficiency and improve health care for the people in the region.
About the NHS and public service reform event series
With reform in health care, education, welfare and criminal justice under way, and a new public service reform White Paper due soon, our breakfast events provide an opportunity to discuss the coalition government’s approach to public service reform and its implications for health care and the NHS.
The first event focused on choice and competition in the context of wider public service reform. The Health and Social Care Bill goes much further than previous reforms in applying market-based principles to the provision of health care and will significantly increase the role of competition and choice for patients.
Your comments
Competition gives brutal, raw results in the short-term & takes time before a refined elegant solution evolves. However, we expect safe equitable progress in healthcare - this implies the need for intelligent design.
If we are to rely on competition in lieu of design, then we need more smaller suppliers so that failure is easily tolerated by the investors & customers (i.e. the taxpaying patients).
An independent Chemist on the high street might come or go but a Hospital matters more.
Steven J Burnell
05 May 11
One of the biggest problems when discussing markets and competition in health is a reluctance to use evidence from other sectors where markets (overwhelmingly) work to bring social benefits to people. Despite the compelling evidence that governments are not good at planning or centrally controlling parts of the economy, we still see arguments deployed against markets in health that seem not to have evolved beyond the arguments used in the1920s and 1930 that communism was superior to capitalism.
It was good to hear a more intelligent perspective at the debate.
But there is one area where more time would have been helpful. Anna Walker's basic point that regulation of markets has to be carefully designed is an important observation. But there has been little discussion of where hospital competition would fit in the picture and many people have made naive assumptions about the degree to which competition is possible. Competition and regulation are hard in sectors like Rail and Utilities as the infrastructure is a natural monopoly (we won't build three different systems to deliver water or electricity to homes, though we though the same for telecoms and now have multiple infrastructures to deliver those services). The assumption is often made that health is like this. But the facts don't agree. In most parts of England the population has multiple hospitals within a reasonable reach of where they live. This means that some closures could happen without significantly lowering access. Some parts of the country (London, for example) have far too many hospitals. This makes hospital competition much easier to regulate (in principle) than rail or utilities.
Specialist services that require critical mass (major trauma, paediatric cardiac surgery) sound like an exception that need to be protected, but the central planning of such services isn't exactly a major success story (why has it taken 2 decades to even start to rationalise children's heart surgery?)
We need more facts and more of the sort of intelligent debate the King's Fund is bringing to health reform.
steve black - pa consulting
06 May 11
It is disappointing to see the Kings Fund does not have the criticality to break out of the bounded presentation of health solely based on competition and choice without really questioning these assumptions.
Professor Proppers presentation is stylished as she says on a certain viewpoint of economists which is not shared by all. Schumpterian creative destruction is always presented as the sole driver of economic growth in a capitalist system independent of technology or context. The use of chronic insecurity in human relationships to drive "reforms" in healthcare appears to be theoritically inappropriate in a sector which has demonstrated that such chronic insecurity has long term deleterious consequences on human beings.
rolf jones
06 May 11