Competition

The NHS Trust sector is now forecasting a surplus of just 0.1 per cent of income in 2011-12, with seven NHS Trusts alone forecasting an operating deficit of over £180 million combined. This is a marked deterioration from previous years and casts further doubt over the sustainability of many NHS Trusts.

For a great many Trusts seeking solutions to entrenched financial problems, the preference has been to merge into ever bigger units. The notable exception being Hinchingbooke Hospital, where the private health care provider Circle takes...

Andrew Lansley's woes are multiplying by the hour this week as efforts mount to block the Health and Social Care Bill.

Resistance might be expected from the British Medical Association (BMA) and the Royal College of Nursing (RCN) and other unions, but it is now more widespread and even reported from deep in his own party, among cabinet colleagues. The public are bewildered and staff in the service doing a difficult job while debate rages and the...

OK, so everyone is fed up with the Bill, just getting on with it, and focusing on having a break. But here are a few things from us to ponder at the end of this unusual year.

Ideological tussles will not go away next year. Alan Garber, now Provost at Harvard and our Rock Carling fellow this year, focuses his gimlet eye on one battle line: what place for competition, what dose, what unit of, and how could it encourage integrated care rather than get in the way.

Alan brings together his long experience of analysis in the US, and his...

I’m only a couple of months into my year in the USA.

Breakfast with Lansley. Lunch with Berwick.  A chance meeting with Obama (Michelle, not Barack). And dinners with more top-rate health care academics, analysts and policy-makers from around the world than would have seemed possible just a few short weeks ago.

With this has come slides – lots of slides. Slides showing how bad things are here. Slides showing how good things are there. Slides showing how Japan is doing its best to make everyone look average, and slides showing how India plans to break the mould in eye-...

The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.

Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.

The second was para 4.24 – in response to...

It is a year since the Government published the outcome of the Spending Review and so fixed public spending allocations for the four years from 2011/12 to 2014/15. The Spending Review led to an 11% reduction in departmental allocations across government (IFS summary of Spending Review, Oct 2010). Health received a comparatively generous allocation with a small real terms increase (0.4% over the four years). 

A year on we have...

If the Government hoped it could draw the sting of opposition to its reform plans by pausing the legislation in early summer, it has been mistaken. As the Health and Social Care Bill is made ready for its second reading in the House of Lords, voices are still calling for the entire Bill to be scrapped. 

Critics argue that the reforms are too disruptive, unpopular and unnecessary. In particular, there is entrenched suspicion of the Government's intentions about the use of the private sector to deliver NHS services, despite the Government’s amendments to the Bill. 

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In the welcome breather from discussions over the Health and Social Care Bill, Nuffield Trusters have had a distinctly international flavour to our work. Professor Alan Garber, soon to be Provost at Harvard, gave our Rock Carling lecture examining how competition can coexist with developing integrated care. 

In the Q&A he gave some provocative responses: don’t rule out all forms of price competition for clinical care; and give GPs some direct (i.e. personal income) incentives for commissioning well.  For more details...

For those interested in a glimpse of how the future might look if the Health and Social Care Bill makes it unscathed into law, the Cooperation and Competition Panel’s (CCP) report on the operation of ‘any willing provider’ is highly recommended.

Not quite summer beach reading material, it is nevertheless a fascinating insight into the tensions that are already present within the NHS and are likely to...

When the NHS White Paper was published a year ago, it diagnosed three main pathologies for which major reform was the prescribed solution: weak commissioning; insufficient competition and choice; and excessive micro-management from the political centre. 

The prescription set out an array of medicines to deal with these ailments including: GP commissioning ‘consortia’ in place of primary care trusts; an economic regulator to promote competition among ‘any qualified provider’ of NHS-funded services; and a new more strategic role for the Secretary of State, with more power and...

The debate about price competition in the NHS is a very good example of a more general point: the impact of competition in health care will depend on the ‘rules of the game’.

The Health and Social Care Bill sets out some of the parameters for competition but much of this is of necessity very broad and open to interpretation.  This job of interpretation falls largely to the new economic regulator – Monitor.  Its approach (or regulatory stance in the jargon) will have a profound effect on the way competition evolves over the coming years.

The market mechanism session of...

Andrew Lansley, the Secretary of State for Health, arrived at the Nuffield Trust summit intending to announce some new developments in Payment by Results.  But the questions and debate following his speech came to be dominated with other questions, including whether the government really plans to introduce competition on price and abolish mandatory NICE guidance in the future.

The audience was rewarded with clarity on the first question. There would be no competition on price, he explained. There...

The third annual Nuffield Trust Health Strategy Summit takes place this week, bringing together senior health leaders, academics and clinicians for two days of reflection and debate on the NHS.

The imminent reforms to the English NHS and the challenge of delivering £20bn efficiency savings form an imposing backdrop to the discussions, and will no doubt provoke much debate and comment, but the summit’s ambition is to look past the headlines and grapple with some of the bigger issues that lie beyond. 

The tangle of ideas that make up ’The Big Society’ will be unravelled and...

Competition is a hot topic with the publication of the Health and Social Care Bill last week. Given the level of interest and feeling this issue excites we decided to hold a round table discussion earlier this year to review the evidence.

Despite what many people may think, for most economists, competition is not an objective in its own right but a tool to achieve the objective of economic growth.  Economic theory and empirical research suggests that competition is an important ingredient in economic...

For the past eleven years, senior academics, policy-makers and practitioners from the United States and United Kingdom have met annually to discuss common areas of work relating to the quality of health care. The meetings are held under Chatham House rules which do not permit the direct attribution of comments. What we offer here is a reflection of the main areas of debate and discussion by Nuffield Trust Senior Fellows Vidhya Alakeson and Ruth Thorlby, supplemented by links to relevant articles, blogs and short podcasts with some of the participants.

It is...

As the coalition government begins to consult on its radical proposals for NHS reform in England, the boldness of the ideas have begun to be noticed internationally. The ideas contained in the recent White Paper, Equity and Excellence: Liberating the NHS, were the subject of much discussion at a recent meeting of policy-makers and academics in Boston, sponsored by the Nuffield Trust and Commonwealth Fund (check back shortly...