The Health and Social Care Bill 2011 will bring on something of a revolution in the NHS – the biggest change since it was established in 1948 – and these developments will all take place in a landscape of enormous financial challenge. The NHS needs to deliver unprecedented productivity gains over the next few years. Many of the changes, such as enhancing the role of local authorities in the health system, giving health-care providers greater autonomy, and radically reforming commissioning to further involve GPs, have the potential to improve care for patients and to enhance the performance of the NHS. .
However, the Bill will also introduce a step change in implementing market-based principles in the health system, with the aim of improving diversity of supply, promoting competition, and increasing choice for patients. While the NHS needs to change, if the scale of change is too big, and the speed too fast, its performance during the transition could be affected unfavourably, disadvantaging patients instead of improving their care and their life chances.
Contributors to this supplement consider how increasing competition in the NHS will affect us. We look at the relationship between citizens and the state and whether the original NHS values can be refounded within this new, broader agenda. How much choice will we actially have and how much influence over our health care? What if, collectively, we make poor choices? Services that are competing against each other will also be required to work together and integrate. How will that work and who will advise us and regulate all of this?