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Nicholson: Competition “confusion” holding back ambitious change

by Lalah-Simone Springer
28 March 2014

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Sir David Nicholson’s biggest regret on retirement is that he did not manage to make clear how competition can be used to improve the NHS, Management in Practice can reveal. 

Sir David – who officially stepped down from his role as chief executive of NHS England this week – told Management in Practice that current views on competition are “holding back the NHS from making changes that are needed”. 

During an interview at Commissioning Live, Sir David said he had been “hopeful” that by the end of his tenure he would have clearly explained how competition relates to the NHS in a way that people could use and understand. 

He said: “The confusion around competition, and the current way it’s being dealt with is holding back the NHS from making the changes that are needed. 

“It’s becoming a disincentive to making ambitious change. I wish I’d got that sorted earlier – I just haven’t had a chance to do it.”

In his final speech as chief executive of NHS England, Sir David said that the Health and Social Care Act was supposed to pull the NHS out of the national and European debates on competition that were happening in 2012. 

“The intent behind [the HSCA] always was that competition is a tool available to commissioners to improve services for their patients – but somehow between that intent, the regulation and the legislation, we’ve lost it,” he said. 

“NHS England as an organisation needs to stand behind you to make it happen. I’m hopeful that we can do that, because I think the place that we’re in at the moment is the worst of all worlds. It is stymieing our ability to improve some of our services for patients.” 

During his speech Sir David revealed that NHS England is working with Monitor to address a lack of guidance for clinical commissioning groups for when services should be put out to tender. 

He said: ‘We’ve been struggling manfully – womanfully – with Monitor to get a simple set of rules that everyone can understand.’

More information on Commissioning Live is available to view online.