Health policy expert urges the OFT to investigate NHS monopolies

Restrictive trade practices are limiting consumer choice

A call for an urgent investigation by the Office of Fair Trading into the role of Primary Care Trusts and District General Hospitals in restricting patient choice was made today by Professor John Spiers* ahead of launching a major new book** on consumer choice in healthcare.

Professor Spiers, Visiting Fellow in Health Policy at the Institute of Economic Affairs, urged an urgent enquiry into the present structure of state-licensed cartels and monopolies. He said: "Primary Care Trusts are local monopolies which restrict patient choice. So too do large District General Hospitals which are protected from competition by the guaranteed income that they receive for Accident and Emergency services directly from government. They are also protected from competition by being the only places where doctor training is authorised, by the necessary clustering of specialists, and by the lack of any contestability for their management."

Professor Spiers commented further: "My understanding is that public services cannot be referred to the OFT or the Competition Commission. However, the Office of Fair Trading, which has been so effective at looking at restrictive practices in the private sector, should have its remit extended to the public sector where the worst restrictive trade practices exist. Its first port of call should be an investigation into Primary Care Trust and District General Hospital monopolies, which constrain competition and very seriously restrict individual choice to the detriment of patient care. Patients should have much more choice of who purchases their care, and huge District General Hospitals should see their management made contestable periodically."

In recent years, Professor Spiers pointed out, the situation has got worse. There is a trend in the NHS towards ‘giantism’: vertically integrated services and local monopoly (aligned with local government boundaries), remoteness, and unaccountability both in purchasing and in provision. In 2006–07 the number of primary care trusts was reduced from 309