Released on 31 January 2012, the report recommends careful expansion of competition among providers of NHS-funded health care in England. It sets out the evidence compiled and analysed by the OHE Commission during 2011 and concludes that:
- Based on the best evidence available, competition at regulated prices has improved the quality of some NHS services.
- Competition can help the integration of care – and there is no evidence that competition hampers integration.
Determining when and where competition is most likely to be effective is a challenge because health care consists of such a wide variety of very different services, delivered in dissimilar locations. To assist in the process of such assessment, the OHE Commission has developed a tool to help define where competition is most likely to be effective; this tool is included in the report.
The report suggests that although competition in the NHS is controversial, 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 where and for which services competition would produce benefit for patients.
The evidence on competition in the NHS is limited, the report notes, but what is available implies that, used carefully, competition 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