Key points
- From 2002 the previous government developed a number of policies to strengthen the role of competition within the NHS. These 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 developed more slowly than the then 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 (Audit Commission 2008).
- Patient choice of hospital has also been slow to develop. Since 2006 all patients have been offered a choice of hospital for elective care. From 2008, patients have had the right to select any hospital provider in England that meets certain standards. About 50 per cent of patients report having been offered a choice by their GP (see Report on National Patient Choice Survey). The coalition government has said it is committed to increasing that proportion and to extending patient choice so that patients have a choice not only of hospital but also of named consultant-led team (see Equity and Excellence: Liberating the NHS).
- 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.
- The coalition government is committed to extending competition. The NHS Commissioning board, together with the Secretary of State, will agree guarantees on patient choice. In most sectors of care any willing provider will be able to provide services. Regulation will be through a joint licensing programme overseen by the Care Quality Commission which will guarantee essential levels of safety and quality and by Monitor which will be responsible for economic regulation (see Equity and Excellence: Liberating the NHS).
- Monitor will be responsible for ensuring that competition works effectively in the interests of patients. It will have powers to apply competition law together with the Office of Fair Trading to prevent anti competitive behaviour. Monitor will also be responsible for setting maximum prices for NHS services where necessary and for ensuring that essential services are maintained. Proposals on the role of Monitor are currently under consultation as part of Liberating the NHS: Regulating healthcare providers.
