Professor Alan Garber on the progress of reform in the NHS in England and how to achieve the right balance of competition, integration and incentives.
This Nuffield Trust Viewpoint, authored by Professor Alan Garber, provides insight into the factors that improve health system performance.
A professional economist and physician by training, Professor Garber is Provost of Harvard University, a former Professor of Medicine at Stanford and the present holder of the Nuffield Trust’s Rock Carling Fellowship. As part of this Fellowship, the Nuffield Trust invited him to review the amended Health and Social Care Bill and explore the question of how to find the right balance between competition, integration and incentives for the NHS, to promote innovation in the delivery of care to patients.
The Government’s NHS reforms pave the way for more competition and a more locally managed health service. They also take place at a time when the NHS in England is faced with saving an estimated £15 to £20 billion by 2015. Achieving savings of this level will require a radical overhaul of how services are designed and delivered. Critical to this is creating the right incentives for the NHS to develop, in ways that promote creativity and innovation.
The clash between the desire to improve services and the need to confront straitened financial circumstances is perhaps the central policy problem for the coalition Government Provost of Harvard University, Professor Alan Garber
Professor Garber’s paper: Competition, integration and incentives: the quest for efficiency in the English NHS, explores how to find the right balance between competition, integration and other incentives.
In his paper, Professor Garber is careful to avoid simple judgements. While sympathetic to integration as a way of delivering higher performance, he warns against the blanket dismissal of competition, observing that when it comes to the organisation of health services ‘we don’t know which approach works best’.
A competitive, flexible approach to delivery is, he argues, more likely to encourage innovation.
This paper is the latest in the Nuffield Trust’s series of Viewpoint publications which provide a platform for international health leaders to share expertise and contribute to discussion and debate on NHS reform. This paper followed the first in our series of Viewpoints, which was authored by Dr Lawrence Casalino, who, as the current Nuffield Trust John Fry Fellow, spent six weeks in England exploring reforms to commissioning in the English NHS.