Blanket use of competition questioned by NHS leaders

Competition in the NHS should be used as a 'rifle shot' to deal with specific issues rather than 'carpet bombing', according to NHS chief executive Sir David Nicholson.

Lord Victor Adebowale: competition can improve services (photo: Pete Hill)

‘Is competition healthy?’ was the subject of panel debate and featured many questions from the audience at the RCGP conference.

Professor John Ashton, joint director of public health for NHS Cumbria and Cumbria County, said wholesale privatisation and a ‘carpet bombing’ approach had already begun.

Lord Victor Adebowale, chief executive of health and social care organisation Turning Point, which provides services for people with complex needs, said: ‘My organisation has provided services for people under competitive situations and improved them.’ But he warned of the cost of preparing unsuccessful bids.

WONCA president Professor Rich Roberts told the conference: ‘Is competition healthy? It’s like asking whether sex is healthy. Perhaps, but only between consenting adults, in the right setting and with sufficient protection.’

Professor Matt Sutton, a health economist at Manchester University, said more research was needed on the effects of competition.

Health economists generally did not expect competition to work, he said, because there were few informed customers or multiple providers.

A GP involved with a clinical commissioning group said the government’s 'any qualified provider' policy, which states that certain clinical areas must be open to competition, was ‘destabilising’ the health economy. ‘My patients want good, local services and are less bothered about choice,’ he said.

Another GP said health services in Brazil, Turkey and Cuba said successful government-funded schemes had shown there was no place for private enterprise in the NHS. Asked which European country they would prefer to be treated in general practice outside of England, Sir David Nicholson said: ‘Scotland. Because of the amount of money per head of population it gets.’

Professor Ashton said: ‘Finland - because its health system has been built on primary care for over 40 years.’ Lord Adebowale said: ‘I’ve never been ill anywhere other than the UK.’

Professor Roberts opted for the Netherlands or Denmark, and Professor Sutton said: ‘Norway because it’s had reform which makes competition between GPs a little more easy. In turn GPs have become more generous with their time, tests and referrals.’

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