More than 40 per cent of commissioners say their organisations are inviting competition for NHS services due solely to their concerns about controversial competition rules, an HSJ survey has found.

HSJ’s latest CCG Barometer, carried out with Capsticks, asked CCG leaders if they had invited – or were currently inviting – competition for services in circumstances where they would have chosen not to but for concerns about the rules.

Eighty senior CCG leaders responded to the survey, of which more than 90 per cent were chairs or accountable officers.

The proportion of commissioners responding yes (43 per cent) increased by 14.3 percentage points from when the same question was asked a year ago, suggesting competition rules, outlined in the Health Act 2012, remain a concern.

A larger proportion of CCG leaders said their organisation had experienced informal challenges under competition, patient choice and procurement rules compared to last year. The figure jumped to 75.7 per cent from 57.4 per cent last April.

The proportion saying they had faced formal challenges under the rules also rose, from 19.6 per cent in 2014 to 26 per cent this year.

This latest survey also saw year on year increases in the proportion of CCG leaders saying that competition rules were responsible for:

  • increasing commissioning costs;
  • obstructing desirable service changes; and
  • hindering plans for the organisational future of local providers, such as mergers.

Dudley CCG chair Paul Maubach said he thought some of the pressure felt by CCGs to put services out to competition was “perceived rather than real”.

But he added that the time it could take to resolve a formal challenge was a significant factor, which could “divert your attention away from getting on with trying to deliver better care” and incur “massive costs”.


He also warned about the “management resource cost that tendering involves”.

“CCGs operate with significantly constrained management resources and need to have the flexibility and freedoms to balance the use of their time appropriately,” he said. “You have to be able to balance the rules against your capacity to act.”

A Conservative spokeswoman said: “We are absolutely clear that there is no obligation on CCGs to put their services out to tender. [NHS England chief executive] Simon Stevens has said that [this] ‘is clearly not true and isn’t happening’. CCGs should always be guided by their judgements about patients’ best interests.”

Questioned by the Commons health committee last year about the impact of the competition rules, Mr Stevens said: “Obviously each case has to be looked at on its merits, but, if the claim was that CCGs had to start putting all of their health service purchases out to public procurement, that is clearly not true and is not happening.”

Responding to the survey findings, a Labour spokesman said: “It is concerning to see, yet again, that commissioners feel compelled by the current government’s legislation to put services out to tender against their wishes.

“That’s why a Labour government will repeal these market rules and end the wasteful compulsory tendering process.”

NHS competition regulator Monitor declined to comment due to the pre-election purdah period.