Health Minister Simon Burns on how well-regulated competition will offer people real choice and help drive up the quality of care
Tomorrow, the House of Lords will begin its reporting on part 3 of the Health and Social Care Bill. For a portion of the Bill’s critics, it’s the most controversial bit, because it covers competition and the role of Monitor in the new health and care system.
Some reform (competition, more private sector involvement) is bad, they argue, and other bits (choice, giving GPs more power) are good.
Get rid of the bad bits by slashing into section 3 of the Bill and the problem is solved. With a simple coup de grace, you prevent competition and privatisation, and our marvellously integrated health system will be saved from fragmentation and total collapse.
For me, these arguments always start from a rather odd place. There’s a tacit assumption that we’re at year zero, as if currently there’s no competition, no private sector involvement, and the NHS today is a seamless model of integration.
The reality is far from the case. There is currently competition, within the NHS itself and, in some areas, from non-NHS providers. There is private sector involvement (which as I said a couple of weeks ago, is very different from ‘privatisation’). Every year, more than 200,000 patients choose to be treated in independent hospitals ‘on the NHS’.
And our NHS and social care system – great as it is in many respects – is not always what you’d describe as a perfect model of integration.
Granted, in some areas we’d like to see more competition, and the Bill helps enable this. We’re doing this because it’s the only way to offer people real choice and it will help drive up the quality of care.
Many of these ‘private providers’, as the critics would call them, are delivering fantastic services. The Horder Centre, a charity that runs a highly successful orthopaedic service for NHS patients in Sussex, was recently named in the Dr Foster Hospital Guide as among the UK’s best providers of orthopaedic care.
Turning Point, a charity, and one of the country’s leading providers for people who suffer from drug or alcohol problems, took over Somerset’s services for people with substance misuse problems in 2008. It is now rated as one of the best services for people with drug and alcohol problems in the country.
It seems bizarre to shut out organisations that have so much to offer for the sake of an ideology that purports to protect the interests of patients.
I can’t put it any better than Sarah Wollaston, in her excellent article in Friday’s Times: ‘Of all the accusations flying around about the reforms, the most damaging is that we could end up with an American-style health service and lose the right to free healthcare. This fear is being cynically manipulated … To imply that this would happen under the reforms is a lie, as is the assertion that only a monolithic NHS can guarantee decent healthcare.’
However, if you are going to open up some bits of the NHS to more competition, you do need safeguards, which is what our legislation will do. So, competition based on quality. No competition based on price, because it’s not about who’s cheapest, but who’s the best. No discrimination in favour of private providers.
You also need proper regulation. That’s where Monitor comes in. The Bill has always been explicit that Monitor’s responsibility is to protect and promote the interests of patients. We went further still on the independent Future Forum’s recommendations, adding new specific duties on tackling health inequalities and promoting choice, for example.
In its new role, Monitor will also be able to prevent the kind of unfair and discriminatory behaviour that led to independent sector treatment centres that were more expensive than the NHS treating NHS patients and often being paid even if they didn’t deliver.
Currently, competition in the NHS is regulated by default by the Office of Fair Trading. So a question you might want to ask is if there is to be competition in the NHS, who would you rather it was regulated by? An organisation more familiar with competition between supermarkets and airlines, or an organisation that actually understands what the NHS is about?
Get rid of part 3 of the Bill and you’ll still have a system that’s only well-integrated in parts. You’ll have limited choice. You’ll still have some competition. You’ll still have some private sector involvement.
The difference is that you won’t have the safeguards the legislation in part 3 puts in place, and you won’t have a regulator that not only understands the health and care system, but also is legally bound to promote integration, choice and to reduce health inequalities.