A key dividing line between the major political parties is the role of competition between providers of NHS-funded care (both NHS and non-NHS) and the extent to which non-NHS providers should play a role in the health system – often described as ‘privatisation’.

In this briefing we consider seven key questions relating to the role of competition and the role of non-NHS providers within the NHS:

  1. Did the coalition government introduce competition into the NHS?
  2. Did the Health and Social Care Act 2012 increase privatisation?
  3. Are NHS commissioners required to put all clinical services out for competitive tender?
  4. Does competition improve quality of clinical care?
  5. What have the different political parties said?
  6. Is the NHS being privatised?
  7. What next?

Key points

There has been a longstanding drive to increase competition between providers of clinical care in the NHS. From the early 1990s this focused on competition between NHS trusts, and from the early 2000s between NHS and non-NHS providers. The coalition government did not introduce competition to the NHS; however, the Health and Social Care Act 2012 did signal a shift in the development of competition within the NHS.

The empirical evidence on a causative link between such competition and quality of care for patients is relatively weak. More evidence is needed before any definitive conclusions on its successes or failures can be made.

The terms 'competition' and ‘privatisation’ are often used interchangeably. However, they are not the same thing. There can be competition between NHS providers without privatisation, and privatisation without competition.

‘Privatisation in the NHS’ has become a catch-all term to mean many different things. During debate, there needs to be clarity as to what exactly is meant by the term.

While the role non-NHS providers should play in the NHS divides political parties, it appears this is reflected to a lesser degree by the public. The British Social Attitudes Survey 2014 found that less than half of the public (39%) reported a preference to receive their NHS-funded treatment from an NHS provider.

Correction notice

A revised version of the document was uploaded on 31 March 2015. Table 4 has been revised to be clearer. The previous version included total commissioner expenditure for 2013/14 to show how the proportion of non-NHS expenditure had been calculated. However, this figure had been included within a column showing spending on NHS bodies. The figure has been removed in the latest version to avoid any confusion.

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