DH acknowledges curb on competition
18 February 2013
BMA arguments regarding competition in the NHS have been partly heeded by the government.
Doctors leaders argued that decisions about whether, where and how to extend choice or use competition should be left to local commissioners. They supported an ‘effects-based approach’ to assessing whether the use or restriction of competition would operate for or against patients’ interests and insisted that increasing competition should not be seen as an end in itself.
This argument that some patients might benefit if competition were to be limited in some cases is acknowledged in the Department of Health’s summary of responses to its consultation Securing the Best Value for Patients, published last week.
In the document, the DH states that Monitor and the NHSCB (NHS Commissioning Board) are working on a choice and competition framework that will help commissioners to identify which types of behaviour could be deemed to be anti-competitive.
However, it adds: ‘There was support for an effects-based approach proposed whereby restrictions on competition would be balanced against any patient benefits, and a general acknowledgement that competition is not an end in itself but rather that it is a tool for driving up quality.’
Devolved decision making
The document cites the BMA’s views several times, including that local commissioners should have flexibility to decide what is best for patients.
It also cites doctors leaders’ call for more clarity in the definition of when restrictions on competition could be warranted. A proposed ‘indispensability test’, to determine when patients’ services were so crucial that they should not be subjected to competition, was a broad term that could be open to interpretation, the BMA argued.
The DH document states: ‘We consider that it is important that restrictions on competition that are not necessary to achieve benefits are prohibited, but we think that the language of necessity is more widely understood than the language of indispensability.’
It adds: ‘During the passage of the Health and Social Care Act 2012, the government amended Monitor’s duties so that its primary duty is to protect and promote the interests of people who use healthcare services. Monitor’s role in relation to competition is not to “promote competition” but to prevent anti-competitive behaviour which is against the interests of patients.’