Choice and competition: those who say we should simply drop part 3 of the Bill are simply wrong

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.

In Conversations, Health and Social Care Bill, News, Simon Burns | Tagged , , , ,

8 Responses to Choice and competition: those who say we should simply drop part 3 of the Bill are simply wrong

  1. Socialinvestigations says:

    This is poppycock. The bill is about privatisation – you only need to look at the list of Lords and MPs with private healthcare financial interests to know this. The contracts are already being agreed with organisations and the CCGs are already being put in place before the bill has passed. there was no mandate for these changes put to the public – all part of the ongoing abuse of this government towards democracy. Corporate servants not public ones.

  2. Ian Greener says:

    Lots of errors here Mr. Burns. You confuse choice with competition (the two are very different) and appear to mix up charities with private provision (although the piece is poorly written so this may be deliberate).

    Most patients don’t choice, they want the reassurance you will give them good treatment. Even where they do want choice (outside of chronic care) it isn’t clear on what basis they would make it. We know less than 4% of patients in your last DH survey actually chose and used NHS choices. To talk of ‘real choice’ is nonsense.

    Decades of economic theory shows us competition doesn’t work in healthcare, and even modern advocates suggest there are no benefits from allowing private providers to compete with public ones. I would suggest particularly you get someone to read Albert Hirschman’s ‘Exit, voice and loyalty’ which will show the potentially awful effects of allowing a large public provider to compete with smaller private ones, and the huge problems that will result for everyone as a result.

    The bottom line is that you won’t be able, either politically or through lack of capacity, to allow large comprehensive public providers of care to fail. That makes competition pretty pointless in many health areas.

    This is more about ideology than sensible, careful, policymaking – that is apparent by declaring opponents to be ‘wrong’ on a government website. We expect a higher level of political debate than this. I agree we aren’t starting at year zero – I’d frankly get rid of private provision out of the NHS as it is already 25% dependent upon the state for its revenues (not much independence there then). This isn’t because I’m against the private sector – it’s because, except to provide extra capacity, there is next to no point in using private facilities to supplement the NHS. There is no sensible basis for competition in healthcare.

  3. Liz says:

    Completely agree….except, the process for registration/compliance with Monitor is so unwieldy, that small healthcare organisations may not have the infrastructure to manage it. Complance with CQC is a massive task for organisations to undertake; add to this a similar process for Monitor and it may put off smaller organisations. Similarly, being commissioned for services by PCTs is even more complex. This will to some extent be addressed by AQP, but nonetheless, all of these issues of compliance require a whole department just to satisfy this aspect of care provision. This kind of bureacracy is exactly what the problem is within the NHS, in order to attain compliance, an army of compliance officers are required; this has a huge cost implication and results in front-line cost-cutting in order to meet back-office requirements.
    The whole process of how healthcare providers function needs to be reconsidered. Tick box and process driven approaches to healthcare is inappropriate. We need to reinstill PRINCIPLES, so that the culture within healthcare is aimed at doing the right thing not merely stating that we are doing it

  4. Rod Whiteley says:

    It’s good to see all this clearly stated. However, Monitor’s role does present some challenges. It has recently been consulting on plans that, as far as I can see, “gold plate” the provisions of the Bill with whatever additional requirements on providers it can think up. The end result might protect and promote the interests of patients in a narrow sense, but at the same time stifle the innovation and diversity that competition is meant to deliver. In America, ham-fisted federal regulation has been implicated in many of the failings of the health care industry and the problems are far from solved. It will be ironic if Monitor replicates that situation here.

  5. Chris says:

    Sounds good – but so do lots of other bits. The problem seems to be in the detail, and that has left a lot of people on both sides of the Atlantic with the feeling that USA health companies can now grow their business into the UK. They are even saying, in their lobbying against medicaid and medicare, that socialised health care doesn’t work – the UK is abandoning it.

    The swarm of management consultants doesn’t inspire confidence, the prospect of taxes having to fund even more management than at present, and profits, and competitive tendering, and bonuses, and the barefaced duplicity of saying “No more top down reorganisation” – and we are expected to believe the end result will be world class efficiency – you do your case no good by implying we are that stupid!

    An efficient, well regulated, competitive market has its place, which is where goods are freely available, and customers have a choice. Sadly, health care is not like that, and cannot be like that without an unaffordably high doctor to patient ratio. In health care, patients are freely available and doctors have a choice – have to choose – who to treat.

    Even with the astronomical fees doctors are paid in the USA they have to rely on immigrant professionals. There is no prospect of commercial suppliers of scarce goods doing anything other than restricting supply to keep prices up. Hence the very high costs in the USA, with worse health care provision! However they are funded, our health care costs will rise if these companies join the party.

    The real solution is to make the NHS as efficient as any private enterprise. With all its built in advantages that should not be too much of a challenge. It needs less management, better management, and its intelligent, competent professionals should be encouraged to hold their management to account if they see anything less than thoroughly professional behaviour. The practitioners who diagnose comlex problems in the complex system that is the human body are more than capable of sorting out the complex organisation that is the NHS. An enlightened management would encourage them to do so. Let them weed out the cancers in the system, and grow the healthy management structure they deserve. Then you will have an efficient world class heath service.

    The NHS is simply very badly managed. Left to run its course your bill will leave it even more expensively badly managed.

  6. Liz says:

    I agree that the NHS is badly managed and currently lacks accountability. There is a growing burden of litigation against healthcare providers and currently, the majority of claims are settled out of court. Along with these settlements goes ‘gagging orders’ whereby the victim is prohibited from highlighting the fact the healthcare provider did them harm. People do sadly suffer from a poorly run and managed healthcare system (in both private and NHS secotrs); quality of care however will never be driven up all the while these providers are not held to account. Alongside ‘competetion’ we need accountbaility. Then patients will be able to choose based on safety records and the quality of care provided – in whichever sector that might be

  7. Stephen says:

    I look at the title of Mr Burns’ article and wonder how on earth the majority of the Birtish public have the sheer bare faced cheek to accuse the Government of adopting an arrogant “the public don’t know what’s good for them, we do” attitude!

    “Choice and competition: those who say we should simply drop part 3 of the Bill are SIMPLY WRONG.”

    Lets just thank our lucky stars that the Government have been dignified and honest enough to keep to the pledge they undertook on page 24 of the Coalition Agreement:

    “We will stop the top down reorganisations of the NHS which have got in the way of patient care”

    NHS – RIP

  8. Sylvie Hampton says:

    How very right you are mr Burns. We are a privately run Wound Healing Centre in Eastbourne and we have been offering an excellent servie to our local NHS now for over 4 years. Our healing rates are the very best and we have been audited by our local PCT who demonstrated the large cost savings we were making in wound care. Privately run does NOT equaste to privatisation and I find it very diffiuclt to listen to people who do not recognise that the NHS is not functioning well at present because there is no accountability – for budgets or for patient care. Private companies will be forced to offer excellence and to be cost effective or they will lose their place in the NHS.