As the era of competition starts to take hold in the NHS, foundation trusts are getting jittery.

The response of the Foundation Trust Network to the draft guidance on how the NHS co-operation and competition panel will handle disputes betrays nerves over what might be about to engulf them.

“Commissioners are anxious to show they can slay a few acute service dragons in their quest to become world class”

Last year HSJ revealed that few primary care trusts had decommissioned anything news. Now panel guidance heavily tilted towards developing an open market is coming into play just as commissioners are anxious to demonstrate they can slay a few acute service dragons in their quest to become world class.

The result, the Foundation Trust Network fears, will be commissioners running amok with tendering - destabilising services, ramping up costs and wasting managers’ time in the process.

Excessive competition, the network claims, risks sacrificing co-operation between NHS bodies.

Ground rules

The network is right to make a robust contribution to the consultation on the ground rules for competition. Not a single PCT has yet excelled at one of the toughest parts of world class commissioning - stimulating the market. This creates a risk that some may use tendering indiscriminately, deploying misguided zeal to compensate for a lack of expertise.

The public and private sectors learned harsh lessons about the pitfalls of tendering in the 1980s and 1990s, when huge quantities of time and money were frittered away on complex bids and negotiations which too often failed to deliver the service or value for money promised.

Tendering can only ever be a cog in a much more complex commissioning machine.

But the network is in danger of writing its own version of St Augustine’s prayer “Grant me chastity and continence, but not yet”. The application process was designed to prepare foundation trusts for precisely this challenge. The era of competition is supposed to be their moment.

Competition will only work if hospitals are forced to close services which do not deliver high quality, a good patient experience and value for money. Fighting off rival bids, justifying why a service should continue and committing to improvements are central to making a success of the health economy that has gradually been built up over the last five years as the alternative to centralised control.