Can competition be good for the NHS?

The most controversial part of the Health and Social Care Bill, currently in the House of Lords, has been the parts about competition.

The government says by further opening up the NHS to private companies, charities or social enterprises, there will be more choice and it will drive up quality.

Critics say it will lead to services closing, hospitals going bust and privatisation by the back door.

At the moment, there are confused signals coming out of government.

Last week the prime minister said competition was not at the heart of the NHS Bill and recently the Health Secretary Andrew Lansley said he had changed his mind on competition, that it was now “a means to an end – not an end in itself”.

But there are no obvious amendments to the bill which suggest either the prime minister or the health secretary has rowed back on this.

So, the question now might be: is there good competition and is there bad competition?

Channel 4 News asked the Department of Health for some examples of good competition and they pointed us in the direction of Whizz-kids. This is a charity which provides wheelchairs for children and young people and now has contracts within the NHS.

The chief executive Ruth Owen said that there are 70,000 children in the UK who need a chair or an enhanced chair. “In the NHS they are not likely to get a powered chair.”

It is a compelling argument. Ms Owen says wheelchairs are like the user’s shoes. They are vital and if you give a child the right wheelchair from the beginning it enhances their lives, giving them not just mobility but independence.

Last year they provided 1,400 children and young people with wheelchairs. They have both competed for contracts with the NHS and worked collaboratively. We saw them at the Tower Hamplets service in London’s East End, where they first worked with the local primary care trust and now have taken over the service.

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‘No systematic evidence’ competition works

But as admirable a service as Whizz-kids might be, critics of the government’s current direction of travel say it is flawed. Allyson Pollock, professor of public health research and policy at Queen Mary, University of London, said that there is no systematic evidence anywhere in academic literature that competition works.

The question for services such as wheelchair provision is, why was the NHS providing it badly? Was it financial or staff factors, for instance? “There should be an incentive to improve from within,” Prof Pollock told Channel 4 News.

“It is a very attractive proposition to think that bringing in new providers, charities, etc, will improve things but all evidence shows that if you move to that new model, over time they become squeezed and their behaviour changes and they become much more like for-profit organisations.”

And, still in the east end, there is an example of where competition could be said to have gone very wrong. In 2007, Tower Hamlets Primary Care Trust gave a 10-year contract to run a local GP surgery to Atos Healthcare, a subsidiary of the French IT company Atos Origin.

Tower Hamlets is an area where a high number of patients have complex health needs and a large number do not speak English.

Three years later Atos pulled out of the contract having failed to improve services to any great extent.

The way competition has been brought in is that they have had narrow specifications. It does not truly meet the needs of the population in the long term. Dr Joe Hall

Now a group of local GPs has taken over the running of St Paul’s Way medical centre in Bow. The same group of GPs, in fact, who had bid to run the contract in the first place.

The GPs, who are all local, have set up a community interest company, to run the practice. Dr Joe Hall told us that over the years they had lived and worked in the area.

“So we know the patients, we have strong links with community organisations such as local schools, pharmacies, housing associations, employment services and welfare and benefit services.”

Although he was not critical of Atos and indeed said they had made managed to make some changes, Dr Hall said that perhaps the “off the peg” one size fits all idea of running a GP practice does not work in a community as complex as Tower Hamelets.

“The way competition has been brought in is that they have had narrow specifications. It does not truly meet the needs of the population in the long term.”

When the contract was handed back, there were warnings that this was a sign of things to come, of private companies being given contracts and then leaving when it does not work out.

We wanted to put this to the health secretary but we were told he was not available for an interview, although he told ITV News: “What is actually at the heart of bill is empowering doctors to deliver better care for patients with the focus on best quality.

“Doctors can use competition to deliver that quality.”