The NHS needs competition—but may not get itby Philip Collins / November 14, 2012 / Leave a comment
Andy Burnham leads a protest against the proposed changes to the NHS (photo: John Giles/PA Wire)
The shadow health secretary, Andy Burnham, is a great fan of Everton football club and no mean player himself. In a distant age I shared a pitch with him as two of the early members of Demon Eyes, the Labour party football team. So I have weekly evidence that Burnham absolutely understands that competition and collaboration are not incompatible. He is well aware that the competition from the other team spurred ours to acts of collaboration in the quest to win the league (which we did, seeing as you’re asking). The Demon Eyes team did not fragment as we competed. Indeed, it was the very act of competition that brought us to a peak of integration.
Burnham might reflect on this lesson in his current post before a false argument traps him into a position from which there is no escape. There is no seminar on healthcare at the moment in which learned people do not talk about the need to integrate the National Health Service. If the rise of chronic diseases is not to consume all the money available, it is said, the fragmented NHS will need to come together. This move, the argument goes on, will require the tempering of previous moves towards competition, which is intrinsically inimical to co-operation.
The implied conflict is a false one. The NHS is a fragmented institution already and any attempt to integrate its many services from the centre is bound to fail. There are great virtues to a more integrated NHS but that goal can only be achieved if services are integrated around individuals, not around the system. That objective will, in turn, require many providers and effective competition between them. Far from being opposing sides, integration and competition run together. But, at the moment, those who are demanding that the NHS simply integrates, as if by magic, are having the better of the argument.
Stripped of the professional vernacular, what does integration actually mean? Someone with an illness will often go through many NHS institutions. Not every medical professional will be located at the same place, nor even have the same employer. The result, from the point of view of the patient, can be a time-consuming mess. A properly integrated NHS would obviate the…