It’s time to ban competition in the NHS

The campaign has officially started and with the NHS a key battleground Labour fires the first shot, capping the profit that private providers can make at 5%.

What were they thinking of?  It’s a small enough margin to keep out innovative private competition, who simply won’t be bothered.  That may be enough to ensure mediocrity for protected monopoly providers, but why don’t Labour have the courage of their convictions?

Surely only 0% profit would ensure total uniformity.  Or are they going to multiply the army of inspectors and regulators who do such a fine job holding everyone to minimum standards?

Of course, any profitable company can decide how much profit to make and where.  Simply increase expenses, salaries and bonuses, or make profits appear in favourable countries such as Luxembourg.  Reducing efficiency to raise costs would work nearly as well, and prevent any nasty “destabilising” noises.

I don’t want to overstate the case against competition.  Someone injured beside the road, for example, should be able to compare ambulance or A&E prices and services from local hospitals.  We must also acknowledge the role that a market in access to healthcare would have in bolstering our deeply unequal society.

NHS England have just announced 37 winners of the Prime Ministers Challenge fund, who won the competition from the 156 applicants.  That means 119 applications were completely wasted.  Why go to all that trouble when DH could have simply handed out the money without the fuss?

We need to expose the contradiction in Labour’s line.  They are using policies, promises, advertising, debates, all kinds of persuasion, to try and win us over.  It looks and smells to me like competition.  Why can’t we simply have one person make all the decisions and have done?

After all, if it’s good enough for modern North Korea, it’s good enough for modern Britain.

Harry Longman
Founder, Chief Executive
GP Access Ltd

PS We are delighted for Stellar Healthcare, PMCF winners from West Essex who phoned yesterday, very excited.  They are one of several who have named us to help with digital access for patients.  Others are still to work out how, and we trust it will be a fully competitive process – turns out to be quite a useful and transparent way to bring about change.

PPS  Julian Patterson describes the “electoral dysfunction”  of our political leaders in his peerless blog Embarrassing Conditions.

2 responses to “It’s time to ban competition in the NHS”

  1. Richard Blogger (@richardblogger) says:

    Is this satire? “Someone injured beside the road, for example, should be able to compare ambulance or A&E prices and services from local hospitals”, this is bonkers, especially since in your bizarre world you are excluding the “benefits” of competition to the unconscious.

    Competition leads to poor services. Pure and simple. Let me explain. In my area the CCG are redesigning services to take them out of the hospital and move them to community settings closer to the patients. This is a good thing, and ultimately could be cheaper and a way to make sure that the increasing number of people with long term conditions get the support they need without breaking the bank. So who is best to design these services? Vitally important are specialists from the hospital – the people currently providing the service. However, in conversations with specialists I have had they say they are reluctant to spend the time designing services for the CCG if the service will go to competitive tender with the chance that they will not be chosen to deliver the service. The result? The people who know nothing about the service – management consultants, or worst, the appalling “lead provider” model when the CCG totally abrogates itself from the responsibility of the service – will be design the service and do it badly. Competition here will lead to a poor service.

  2. Harry Longman says:

    To grant it the level of satire is perhaps too kind, but ironic, yes. There are many examples where competition is likely to be a poor mechanism for good and efficient service.
    But my wider point is that competition may in other cases lead to better services. You give an example where in your view it hasn’t. Let’s reduce both arguments to the absurd:
    1. Competition is always good – choice of ambulance at the roadside? I don’t think so. An entirely market driven system of insurance and supply, the USA at twice the cost of UK? I don’t think so.
    2. Competition is always bad – the state always knows best, dictates who shall have what, awards contracts on its own arbitrary terms, quashes innovation, and assumes by the way the perfectibility of human nature. I don’t think so. If you believe in this kind of utopia, options are running out and I think North Korea is your only haven.

    in some parts of the NHS market competition may be beneficial, in others not so. The questions are: what works, how and why does it work, how can it work better?

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