Despite increased competition raising fears, in some quarters, for the future of the NHS, now is not the time to play it safe - but to harness its power to do great things, says Sir Stephen Bubb.
“Competition is not a disease.” That was the message I gave the cabinet when the NHS Future Forum presented its reports back in June. The reality is that if we want more choice for citizens in health, we need a greater diversity of providers. And that means a big expansion of the third sector’s role. It means taking on the vested interests in the health service.
For too long those vested interests have thought the health service belongs to them. It doesn’t. As the NHS constitution says, it belongs to “the people”. And it is time the people reclaimed it.
Doctor does not always know best. The increase in the older population, the marvellous advances of medical science, the need to grow community responses to long term conditions and to integrate health and social care all demand reform. And that is even without the knowledge that resources are finite.
It’s not about whether competition is good or bad, but how we harness competition to deliver more choice, while limiting the downsides and promoting the benefits of regulated competition. The tired old debates about privatisation have got in the way of us having a proper debate on how to benefit the citizen and patient. So let’s get cracking on that and leave the dinosaurs where they belong: in ancient history.
Back to the present day and there’s a different story to be heard on the ground – that if we want the best services for patients, we cannot afford to exclude a diversity of providers. Third sector organisations can deliver high quality, innovative services. Addaction’s Breaking the Cycle programme is just one. The programme addresses the complex variety of needs experienced by families in which parents abuse drugs.
Evaluation shows that, of the families involved in Breaking the Cycle, 81 per cent significantly reduced their use of drugs or alcohol, 81 per cent put the needs of their children first, 86 per cent significantly improved their skills as parents, 77 per cent were more stable and less chaotic, and 86 per cent improved their financial prospects by looking for work, volunteering or going on college courses.
Seven months of Breaking the Cycle support for one family costs £1,700. Within eight months, that is likely to have saved the state £20,000. Within two years, it is likely to have saved £148,000. Over the long term, the effects on two generations of that one family could save the state £880,000. Why would commissioners deny the public access to efficient and cost-effective services?
We cannot afford to fear competition. Yes, the government’s initial plan to give Monitor “a duty to promote competition” was clunky and it may well have been unworkable. But the listening exercise did bring increased clarification to the role of competition in the NHS. Through citizens exercising their right to choice, we can harness competition in the service of patients. Of course, competition needs to be regulated and we need adequate safeguards. But it must be part of a wider toolkit for delivering choice if we are to improve the quality and integration of our health services.
The evidence is clear on this. Studies from the London School of Economics and Bristol suggest that competition can save lives. It is well known that giving patients with long term conditions more power over their care can improve outcomes.
More than 15 million people in this country live with long term conditions. In 2009-10, an estimated £70bn was spent on their care. Put simply, an unsustainable situation. We must give people increased control to better self-manage their conditions and reduce unnecessary hospital admissions. Financially, it’s a no-brainer: the NHS can and should go much further to offer choice to patients.
With increasing financial pressures on the NHS, now is the time for reform, not to turn tail or play safe. Rather than dismantling these provisions any further as the bill moves through the Lords, debate must instead explore how regulated competition can be used to drive choice, how we can minimise the risks and how we might use competition to promote integration in our NHS. The alternative is that the NHS will fail to deliver real choice for patients and we cannot afford for that to happen.
Sir Stephen is chief executive of the Association of Chief Executives of Voluntary Organisations and a memeber of the NHS Future Forum.