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NHS competition 'not about ideology'

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Healthcare sector regulator Monitor and the NHS Commissioning Board have issued a joint statement of intent on how competition would work in the reformed health service, amid continuing political controversy about the government’s NHS competition regulations.

Health reporting HSJ and LGC logo

Commissioning board policy director Bill McCarthy told LGC’s sister title Health Service Journal that the statement showed the board and the regulator were “completely aligned” on “five key points” about how and when competition should be used. He said these were:

  • That “patients come first”, and the “determinant of how we use competition is always going to be ‘how is this in the patient interest?’”
  • That competition “is about evidence, not ideology”. “A lot of the debates have been either legal or ideological debates,” said Mr McCarthy, but both the board and Monitor agreed “the evidence of what” will improve outcomes for patients “is what matters”.
  • That it is for “commissioners to decide” if and when to introduce competition beyond the rights to choice set out in the NHS constitution.
  • That the first three principles are not a “green light for poorly performing incumbents” and where there is poor performance there is “an expectation that commissioners will use all of the tools available, including competition where that’s evidenced”.
  • That “we do need to strengthen the evidence base” on the potential benefits of introducing competition.

Mr McCarthy added: “No one is going to take any steps to persuade or push or force commissioners to use competition where there’s no evidence that it’s of benefit to patients.”

Competition regulations published by the Department of Health last month sparked accusations that the government had reneged on a commitment, during the passage of the Health Bill, to let clinical commissioning groups decide when a service should be tendered. The DH redrafted the regulations in response to the criticism, but Labour last week tabled a Commons motion calling for the revised regulations to be annulled.

Asked how he believed the principle of “the commissioner decides” could work within the regulations as they stand, Mr McCarthy said: “I’m not a lawyer, but I know that ‘the commissioner decides’ is completely consistent with ministers’ statements previously… this is Monitor signing up to that as well.

“I think it’s pretty clear, and it’s got sign-up from all of the important players.”

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