Choice and competition

The Health and Social Care Act 2012 requires commissioners to ensure good practice and to promote and protect patient choice. Choice and competition are among many tools that a commissioner may decide to use to improve services for patients. It is for commissioners to decide if, when and how to use competition. Commissioners will need to act transparently and be able to demonstrate the rationale for their decisions in terms of patient interests.

The act also sets out the parameters on choice and competition within which NHS  England and Monitor will work.

  • NHS England must act to give patients choices about their health service provision.
  • Monitor must act to prevent anti-competitive behaviour in the provision of health-care services for the NHS that is against the interests of patients.

What are NHS England and Monitor doing about these issues?

NHS England and Monitor are working in partnership to develop a choice and competition framework for commissioners, informed by commissioners. The framework aims to help commissioners decide how and when to best use choice and competition to improve outcomes for patients, thereby supporting good practice and helping commissioners to promote and protect patient choice.

Monitor’s and NHS England’s work includes exploring:

  • Where choice and competition are heading (in policy terms) and why they are important.
  • How much choice and competition currently exists and where.
  • How much more choice and competition can be achieved and by when.
  • Risks that may arise in promoting choice and competition.
  • How choice and competition could be delivered to greater effect.
  • How progress and impact can be monitored and evaluated.

The framework will evolve as the project proceeds but the current emerging vision is for it to:

  • Be a suite of interdependent and interconnecting products, including tools and case studies;
  • Draw this range of products together in one accessible place and
  • Provide a user-friendly, interactive platform to support its use and its evolving nature, keeping users up-to-date on the latest developments.

NHS England and Monitor are co-developing the framework with commissioners and providers, as potential users, and are involving them in:

  • Developing the concept and purpose of the framework;
  • Developing the content and
  • Developing the interface through which the framework will be made available to users.

In its June 2011 report, Choice and competition – delivering real choice, the NHS Future Forum highlighted the role of competition in the NHS as a tool for commissioning clinical services where it serves the interests of citizens and choices they wish to make. NHS England and Monitor are working in partnership to develop a choice and competition website and have published a note setting out how the website will help commissioners and providers understand where competition may deliver improved outcomes for patients.

Co-developed with commissioners and providers, the choice and competition website will bring together for the first time in one place all of the key material that has a bearing on choice and competition in the NHS in England. Consistent with the principle that it is for commissioners to decide if and when to introduce choice or use a competitive procurement process, the website will evolve as experience and evidence grow over time, sustaining an absolute focus on improving patient outcomes above all else.

How you can get involved

We are keen to hear your views on the framework. NHS England and Monitor have held interactive workshops and attended commissioning events around the country to discuss the framework and choice and competition issues with CCGs and providers.

Building on this work, we are seeking input from colleagues in CCGs and provider organisations in the following areas:

  • CCG and provider user testing;
  • Choice and competition tool development and
  • Web interface user needs, design and build.

This work will run until the beginning of 2013. You can email  for further information, including on how to get involved, or to provide comments.

We will also be responding to Tweets on the Framework via the #choiceandcompetition hashtag on Twitter.