The drive to open up public services to competition has proved controversial, nowhere more so than in the NHS. Sir Stephen Bubb, chief executive of the Association of Chief Executives of Voluntary Organisations, wrote to David Cameron earlier this year raising concerns that public sector monopolies could be replaced by 'private-sector oligopolies'. Large private sector providers are cornering new markets in public services at the expense of charities and other smaller community-focused organisations. Bubb argued that contracts are too often focused on cost savings rather than "engagement, collaboration and social value".
Big is not necessarily beautiful when it comes to addressing ingrained, complex and costly health challenges. Organisations that are close to their communities can respond to their needs in a more targeted way. Their understanding of their client group enables them to identify pockets of unmet need and find innovative solutions, while engaging and galvanising local communities and helping to co-ordinate services across a range of organisations.