Choice regarding healthcare providers was largely determined by financial status and social standing until the introduction of the NHS in 1948, which introduced the provision of services free at the point of use for all (with some exceptions such as prescriptions).
Competition has been a contentious issue since the founding of the NHS, and it remains so today.
Ever since it was founded in 1948, the NHS has effectively been a large monopoly, albeit with national contracts to general practices as independent providers of primary care. There was a drive to introduce competition for the provision of clinical care in the NHS from the early 1990s onwards. The NHS has made use of non-NHS providers such as general practitioners since its inception; however, it is only during the last 15 years that non-NHS providers have been able to compete directly with NHS providers to provide NHS-funded clinical services. NHS spending on non-NHS providers increased during the last parliament.
The role of competition and by extension the role of the independent sector in delivering NHS-funded clinical services has been one of the major dividing lines during the recent election period. There is confusion surrounding what competition and ‘privatisation’ means for the NHS. The portrayal of the debate in the media has focused on the extent to which the Health and Social Care Act 2012 has opened up the NHS to private provision, which plays into the public concern that the NHS could be eroded or that people might be required to pay for services.
The timelines chart the various developments that have led to our current approach to competition from the 1940s onwards. Unlike some policy areas that we have covered in the Navigator website, the choice and competition theme charts incremental policy change. Over the course of this parliament we could see something quite different.