Public health expert David Lawrence explains why competition and marketisation aren’t the change that the NHS needs. 

The NHS in England was once a collaborative and cooperative public service, with the aim of reducing our suffering, and improving our health. Over the last 30 years, successive governments have introduced more and more elements of competition, contracting and privatisation, including the purchaser-provider split, the Private Finance Initiative and ‘any qualified provider’. There are several reasons why this is not good for us.

1. Competition Creates Bureaucracy

Public financing, using general taxation and public, non-profit healthcare, has lower costs than a part-market system with for-profit providers and mixed public and private financing. The traditional NHS (pre-1980s) had low management costs of around 5%. That was perhaps too low, and required more expenditure on expert management data collection and systems management.

The Health Select Committee has noted that, by 2005, the internal market had increased…