Competition

So now we know that Nick Clegg does not want Monitor to promote competiton:

"There must be no change in the way competition law operates in our NHS. No to establishing Monitor as an economic regulator as if health care was just like electricity or the telephone and no to giving anyone in the NHS a duty to promote competition above all else."

That is nice to know. I wonder why, if Nick Cleggis so much against competition, he did not notice that competition was one of the principle parts of the Bill?

We also know that Lansley (fingers crossed behind his back) says:

modernising the NHS is "about competition as a means to an end, not an end in itself"

and

the economic regulator should promote competition "where appropriate" and use regulation "where necessary"

Lansley's behaviour does not sound very liberating. So let's have a look at when the White Paper says.

GP consortia will need to have sufficient freedoms to use resources in ways that achieve the best and most cost-efficient outcomes for patients. Monitor and the NHS Commissioning Board will ensure that commissioning decisions are fair and transparent, and will promote competition. (4.6)

The and will promote competition is ominous. It certainly sounds like Monitor will not just regulate competition, or prevent unfair competition, as seems to be the narrative from Lansley at the moment. The section says quite blatantly that Monitor will make sure there is competition.

Our aim is to free up provision of healthcare, so that in most sectors of care, any willing provider can provide services, giving patients greater choice and ensuring effective competition stimulates innovation and improvements, and increases productivity within a social market. (4.26)

Again, this certainly reads like competition will be forced upon the system, because the section implies that innovation will not be possible without it.

The Role of Monitor: Promoting competition, to ensure that competition works effectively in the interests of patients and taxpayers. Like other sectoral regulators, such as OFCOM and OFGEM, Monitor will have concurrent powers with the Office of Fair Trading to apply competition law to prevent anti-competitive behaviour; (4.27)

Again, we read that Monitor will promote competition, although here the emphasis is on preventing anti-competitive behaviour (ie those providers who refuse to compete).

Monitor should have proactive, “ex ante” powers to protect essential services and help open the NHS social market up to competition, as well as being able to take “ex post” enforcement action reactively. Ex ante powers would enable Monitor, for instance, to protect essential assets; require monopoly providers to grant access to their facilities to third parties (4.28)

This is more concerning. The section specifically says that the intention is to open the NHS social market up to competition, ie to force competition on the NHS. The second highlighted phrase indicates that Monitor will allow private providers to use NHS hospital facilities. (For example, a MRI or CT scanner, Monitor will force NHS hospitals to allow private providers to have access to those facilities paid for out of NHS funds.)

All of this fits in with what Oliver Letwin said before the election:

"We will implement a very systematic and powerful change agenda where hospitals compete for patients, schools compete for pupils, welfare providers compete for results in getting people out of welfare and into work."

That certainly sounds like competition for competition's sake.