Lansley's curse on competition

February 28, 2012
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Andrew Lansley’s health reforms are an albatross hanging around the Coalition’s neck. The health secretary’s inability to sell his flagship policy to the electorate has arguably made the bill politically unviable. Criticism from the left and right, perhaps most significantly Conservative Home editor Tim Montgomerie’s call to scrap the proposals, have wounded Lansley to a near fatal extent.

Yet, while the politics behind the reforms have been disastrous, are the principles that underpin the Health and Social Care Bill worthy of such vitriolic opposition? Today, the centre-right think tank Reform argues that competition, one of the most controversial clauses in the bill, is integral to the future survival of the NHS.

If hospitals compete with each other, so the theory goes, then costs will be driven down, patient choice improved and efficiency increased. Competitive measures implemented by the last Labour government resulted in a reduction in the average length of stay in hospital. Indeed, while Ed Miliband may be firmly against the Coalition’s reforms now, the 2010 Labour manifesto that he wrote actually committed his party to increased private sector involvement and "tough…sustained reform."

The evidence released by Reform seeks to use case studies to add weight to the competition argument. In Rhode Island the use of private sector companies has reduced the cost of hospitalisations for mentally ill children by 20 per cent in one year. Inviting private providers to organise care for low income elderly people in Massachusetts has seen the number of nursing hospital admissions fall by some 42 per cent. One public hospital in Germany, a nation which ranks considerably higher than the UK in health league tables, has been able to make savings up to 25 per cent above the national average by using private services.

There are many things wrong with Andrew Lansley’s NHS reforms. The decision to renege on David Cameron’s promise of no more top-down reorganisations will be costly both politically and financially. The bill itself is fraught with inconsistencies. There is very little evidence that the introduction of clinical commissioning groups will do anything to improve patient care, which is surely the aim of any health reform. The lack of support from doctors and nurses does nothing to portray the government in a flattering light. Overall, there is a very strong case for dropping the bill altogether. There are too many flaws, and the politics may be too damaging.

Yet competition is not one of those flaws. As a principle, increasing the competitive element should help improve efficiency in a National Health Service that is in desperate need of change. The evidence from Reform today convincingly supports this. Competition need not be an ideological issue; it has its supporters and its detractors on both sides. Whatever happens to the bill in its current form, the government should not abandon its key belief: competition is good for the NHS.

Alexander Wickham is a freelance journalist and blogger. He has also written for The Independent and Total Politics. He tweets at @Wickham_A