The government is committed to the founding principle of the NHS, that treatment is free at the point of delivery and available according to clinical need rather than ability to pay. However, independent, voluntary and private organisations have always been part of NHS services. For example, most GPs are private contractors, and the medicines the NHS buys are manufactured by private companies. What people say matters to them most is the quality of care they receive and that they receive it free when they need it.
The government believes that competition between providers will be a means, not an end, to empower patients and staff, to drive up responsiveness, outcomes and efficiency, and provide the best value for money for taxpayers.
Key to this will be the new economic regulator, Monitor. It will promote choice and competition to ensure that all providers can compete fairly and transparently, and it will have powers to address any anticompetitive behaviour in order to protect the interests of patients and taxpayers.
Patients will continue to have a choice of who provides their NHS services. They will be able to choose an appropriate provider based on information about the quality and accessibility of those services. Providers from all sectors, including NHS trusts, social enterprises and the independent sector will continue to have a role in providing NHS services.
The key criteria will be whether they can deliver the service to the standards set out in the National Standard Contract, whether they are registered with the Care Quality Commission, and whether they can deliver the service for the price the NHS is willing to pay.
Choice of provider has been in place for elective hospitals for some time, and has been extensively researched and evaluated. It should particularly benefit those social enterprises and voluntary sector organisations providing community and mental health services that have often found it difficult in the past to secure contracts from primary care trusts, despite offering excellent responsive services.
Competition will enable existing good providers who offer innovative and responsive services to grow. Potential new providers who can meet the standards and prices set by the NHS can enter more easily, enabling innovation and enhanced patient choice of both providers and, in some cases, treatment, whilst ensuring that quality and safety remain paramount.
The government listened to stakeholders and members of both Houses of Parliament, with a view to improving the Health and Social Care Act’s regulations and removing any scope for misinterpretation. The Government introduced new regulations on 11 March clearly state that there is no requirement to put all contracts out to competitive tender. This means that commissioners are able to offer contracts to one provider where only that provider is capable of providing the services. The healthcare regulator, Monitor, has no power to force the competitive tendering of services, ensuring that decisions about how and when to introduce competition is solely up to the doctors and nurses in clinical commissioning groups.
Also, competition should not override integration, which commissioners should use where it is in the interests of patients.
A copy of the new regulations, along with supporting documentation that sets out in more detail what changes have been made, can be found at Regulations on procurement, patient choice and competition.