Competition and integration

^{Dr David Bennett, Chair and Interim Chief Executive at Monitor, on Monitor’s role in promoting competition and the integration of health care services}

Extending competition between NHS and independent providers for both patients and contracts has been an explicit policy objective for the NHS in England since the early 2000s.

In June 2010, the Government’s White Paper: Equity and Excellence: Liberating the NHS affirmed their belief that competition is an important way of driving quality and efficiency in the NHS and set out their plans to extend the scope of patient choice and competition beyond elective hospital care, to other areas of hospital and community care.

The subsequent draft legislation proposed the creation of new structures to support competition, specifically a new economic regulator for health (Monitor), with duties to promote competition and a range of powers to combat anti-competitive behaviour.

Monitor will play a key role in driving integrated care and in sharing examples of good practice across the NHS, but it will not be acting alone. Commissioners should be the main drivers, but providers also need to be encouraged to provide integrated solutions

Dr David Bennett, Chair and Interim Chief Executive, Monitor

One of the key messages from the NHS Future Forum report published in June 2011 in response to concerns about aspects of the proposed legislation, was that health services in England should be much better integrated (both within health care and between health and social care services), so that patients experience well-coordinated, seamless care. Monitor now has a duty to protect and promote patients' interests and take action against anti-competitive behaviour in the NHS, while at the same time supporting the integration of services where this improves care.

This event report summarises the presentations and discussion from the Nuffield Trust and Monitor partnership roundtable held in September 2011 and explores some of the challenges that will face Monitor and the NHS Commissioning Board in the dual pursuit of competition and integration. It draws on the latest evidence from international research and on examples from the US.

This event report will be of interest to commissioners, policy-makers, and all those interested in the reform of health care and public services.