COMMENT
fear and opposition among many health professionals and politicians? Polling suggests the public are also unconvinced: on the question of whether increasing the amount of competition in the NHS will make services better or worse, a YouGov poll in February showed only 19% thinking competition would help services, and 49% thinking it makes services worse (with a further 17% saying it would ‘make no difference’ and the rest did not know). This is almost exactly the same as the numbers of people supporting and opposing the whole Bill – 18% in favour compared to 48% against – suggesting that the issue of competition has become closely aligned with the Bill as a whole for many voters.
advantage of simple cases is a “completely unfounded” fear.
Cawston said: “The bigger question here is how do we get the kind of transformation in healthcare we need in the timescale we have? That can only be achieved by having new entrants and competition between providers, because services won’t change unless they have a reason to change. At the moment we’re not giving them one and I think competition is the best way to do that.”
Can’t turn back the clock
In terms of the wider reforms to the NHS, Cawston believes that while the commissioning restructuring elements of the Bill have impacted negatively on the health service, this is something that can no longer be fought.
He said: “The commissioning reforms have been disruptive, confusing and have created a lot of complexity in the system and also led to a more centralised system which has made accountability less clear. Those changes have already happened. We’ve already had commissioning groups pop up around the country, commissioning clusters have been formed, the regional health authorities have been reformed, the National Commissioning Board is almost up and running. Those things have happened and you can’t stop them now.
“However, the other part is the competition reforms, which are creating a level playing field by making Monitor the regulator for the entire NHS, not simply foundation
trusts, for both NHS providers and non- NHS providers. It’s bringing in a fairer regime, all the things we know will create pressure on providers to improve and transform themselves.
“Unfortunately we’ve reached the point now where you can’t turn back the clock on the commissioning reforms, but if we drop the Bill now we will lose the reforms to en- able greater competition in the NHS.”
Cawston believes that the competition element of the legislation is in danger of being lost and states that the Government is at a point where they “can’t afford to concede anymore”.
Concessions up to this point have included changing Monitor’s role, revising several key proposals and scaling back
the
reduction of any qualified provider to a “very narrow” collection of services.
If the Bill is passed – as looked inevitable as NHE went to press – the Government will have the necessary building blocks to drive pressure on providers to become more efficient in the future, Cawston said, and will “have to once again make the case for a NHS that’s going to look and be very different but will deliver better value and better quality and welcome the new providers and new forms of care that we’re seeing around the world right now”.
Historical hostility
But if competition has such a beneficial part to play in the health service, then how does Reform explain the amount of
Cawston said he couldn’t speak for the organisations that have historically been hostile towards competition, but added: “Ultimately the Government’s point itself has become equivocal. They started by saying: ‘We will let any willing provider come in and innovate and transform the NHS, we want an open, level playing field, an open market.’
“That was back in June 2010 and come March 2011 they were already beginning to backtrack and say ‘any qualified provider’. Then you saw David Cameron attacking competition under the last Government; he mentioned that the ISTCs weren’t effective, and Andrew Lansley said we wouldn’t allow competition when it undermines NHS providers. They were very quick to rule out price competition. The position has become much more muted now.”
Questioned on whether the many concessions and amendments to the Bill have actually benefited the legislation at all, Cawston suggested that they had “led to more complexity in the system” and that the amendments to the competitive measures in the Bill “did weaken it; it made Monitor’s role much less clear”.
He continued: “It has a number of objectives now; it’s not clear what they’re meant to be doing. It did push back the deadline for all trusts to become foundation trusts and scaled back any qualified provider to a few services rather than a lot.
“The key thing is that the Government can’t afford to concede anymore.”
Thomas Cawston FOR MORE INFORMATION
Visit
www.reform.co.uk/resources/ 0000/0364/Healthy_competition.pdf
national health executive Mar/Apr 12 | 21
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