Report: Competition Can Help the NHS – But Proceed with Care

Report of OHE Commission on Competition in the NHS

The Office of Health Economics (OHE) has just released the report of its Commission on Competition in the NHS, which recommends careful expansion of competition between providers of NHS-funded health care in England. The report sets out the evidence compiled and analysed by the OHE Commission over the last year, and the conclusions it draws, including that:

  • On the best available evidence, competition at regulated prices has improved the quality of some NHS services
  • Because health care consists of a wide variety of very different services, delivered in dissimilar locations, the OHE Commission has developed a tool to help show where competition is most likely to be effective
  • Competition can help the integration of care – and there is no evidence that competition hampers integration

Competition in the NHS is controversial, but in the right circumstances it can be used to stimulate the provision of better health care than is achieved without competition. This does not mean that competition is desirable or feasible for all NHS services in all locations. The issue is not whether to have competition for all NHS services or for none; the question is for which services and where competition would benefit patients. The evidence on competition in the NHS is limited but implies that, used carefully, it can benefit patients. The OHE Commission recommends:

  • That where current providers’ performance suggests health care could be improved, competition should be given serious consideration
  • The likely effectiveness of competition can be assessed before it is tried – using the analytical tool developed by the OHE Commission and described in the report
  • “Any qualified provider” arrangements allowing patients, helped by their GPs, to choose where to get their health care are suitable in some cases
  • In other cases, competitive procurement by local NHS commissioning bodies on behalf of the populations they serve will be more appropriate
  • Routine collection and publication of patient outcome measures should continue to be expanded to enable evaluation of the effects of competition


Additional information on the Commission is available in the Featured Projects section of this website.


Download Report of the Office of Health Economics Commission on Competition in the NHS. (2012) London: Office of Health Economics.

The Commission also commissioned three background reports, available for download below.

Download Forder, G. and Allan, S. (2011) Competition in the care homes market. Report for the OHE Commission on Competition in the NHS. London: Office of Health Economics

Download Goudie, R. and Goddard, M. (2011) Review of evidence on what drives economies of scope and scale in the provision of NHS services, focusing on A&E and associated hospital services. Report for the OHE Commission on Competition in the NHS. London: Office of Health Economics

Download Mordoh, A. (2012) Critical review of the quality and competition measures and identification strategies used in health care studies. London: Office of Health Economics.

Presentation from launch event

Contacts for further information Jon Sussex, Deputy Director, Office of Health Economics -- E-mail:

Adrian Towse, Director, Office of Health Economics -- E-mail:

Telephone: +44 (0) 20 7747 8850

Posted in Competition, Health Care Systems | Tagged Commission