Competition in the NHS: Proceed with Care

The role of competition in the NHS is again in the news. Sir David Nicholson, Chief Executive of both the NHS in England and the NHS Commissioning Board, voiced his concern at a Royal College of General Practitioners conference last week, saying: “It [competition] is very effective when it is used as a rifle shot to deal with specific issues rather than a carpet bombing”. We agree.

The role of competition in the NHS is again in the news. Sir David Nicholson, Chief Executive of both the NHS in England and the NHS Commissioning Board, voiced his concern at a Royal College of General Practitioners conference last week, saying: “It [competition] is very effective when it is used as a rifle shot to deal with specific issues rather than a carpet bombing”[1].

We agree.

The NHS provides services to patients from birth to death, in hospital and the community, and for all phases of care, from emergency treatment through prevention and care for chronic diseases.  Given the great breadth and variety of needs and situations in the NHS, competition can be neither always appropriate nor always wrong.

The OHE Commission on Competition in the NHS came to very much the same conclusion as Sir David in its independent report published earlier this year.  This group of experts in competition/regulatory economics, NHS economics, health policy, NHS management, and health care provision spent a year extensively reviewing the available evidence. The Commission concluded that competition could be a valuable tool in situations where current provider performance can be improved and where the characteristics of the particular NHS service make competition feasible.

The OHE Commission’s published report not only reviews the evidence, but also includes a simple tool to help commissioners of NHS services decide where competition is likely to be most feasible.

Download Report of the Office of Health Economics Commission on Competition in the NHS. (2012) London: Office of Health Economics.