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Will 1 April mark the beginning of the end of England’s NHS? No

BMJ 2013; 346 doi: (Published 26 March 2013) Cite this as: BMJ 2013;346:f1975
  1. Julian Le Grand, Richard Titmuss professor of social policy
  1. 1London School of Economics, London, UK
  1. J.Legrand{at}

The government’s changes to the NHS in England come into force on 1 April. David Hunter argues that they will result in creeping privatisation and destroy the public service ethos but Julian Le Grand (doi:10.1136/bmj.f1951) thinks that more competition will improve the quality of care

Will the coalition government’s changes to the health service mean the end of the National Health Service in England? They will not.

The current wave of concern is around the proposals relating to the competition proposals and especially those emanating from section 75 of the Health and Social Care Act. The fear seems to be twofold: that these will encourage competition and that the competition will come from the private sector, hence privatising or hollowing out the “real” NHS.

Competition works

The fear of competition itself is misplaced. We now have considerable evidence that increasing competitive pressure does indeed provide the challenge that NHS hospitals apparently need if they are to improve. Cooper and colleagues at the London School of Economics found that, during the period when patient choice was introduced in England, hospital quality improved faster in more competitive …

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