Central to the 1990 reforms of the NHS was the idea that by separating purchasers of care from providers, with the purchasers holding the money (but no services) and the providers services (but no money), the transactions that would need to take place would drive up quality and efficiency. Health authorities would be active purchasers of care on behalf of their resident populations. And in this 'internal market' there would be freedom to shop around for the best deals from any organisation willing to supply, whether state owned or independent sector.
There have been several reboots of the original idea since then. Internal market 2.0 from the 2002 Labour administration emphasised patient choice and encouraged more private providers of NHS secondary care through financially favourable contractual terms. Internal market 3.0 – the reforms of the last government’s Health and Social Care Act – reasserted the basic market model with a twist of EU procurement law and revamped commissioning staff (I characterise).
Nevertheless, the central theme remains. So, after a quarter of a century of purchasers having the freedom to purchase from, or patients the ability to choose, NHS or independent sector providers what’s happened? How many patients is the private sector treating on behalf of the NHS?