Key points
- From 2002 onwards a number of policies have been developed to strengthen the role of competition within the NHS. These have included:
- introduction of new private sector providers, particularly for elective care
- development of patient choice, supported by a new system for paying for hospital services known as Payment by Results
- monitoring of quality by an independent regulator
- creation of a new form of organisation known as foundation trusts that have freedoms to raise capital and develop new services
- separation of community services from primary care trusts, opening the way for these services to be subject to competition and for new forms of enterprise including charitable organisations and social enterprises as well as the commercial private sector to expand their role.
- Competition in the provision of elective care has developed more slowly than the government originally expected. Although it did not set a target for the independent sector’s share, a figure of 15 per cent was sometimes suggested by ministers. In 2007/8 the share was less than 2 per cent. However, there are now more than 100 fixed site or mobile private sector units providing care for NHS patients.
- Patient choice of hospital has also been slow to develop. About 50 per cent of patients report having been offered a choice by their GP.
- Networks for the provision of cancer, cardiac and stroke services have been established over the whole of England. There are a large number of local networks, some covering both health and social care.
- In 2008 the Department of Health issued guidelines to the NHS on management of the introduction of competition and the maintenance of co-operation. The responsibility for implementing these lies with primary care trusts and strategic health authorities.
- The Co-operation and Competition Panel was established in 2008 to resolve competition issues where there is local disagreement.
