Markets, mergers and mixed messages

Choice has become the defining characteristic of service users’ relationship with the NHS in England. Decades of market-orientated policy have encouraged greater customer focus, and the NHS is now subject to the same consumer drivers that can be identified elsewhere in society. Competition between service providers is intended to encourage improvements in efficiency and ensure services are more responsive to users’ needs. In 2013, the Competition Commission intervened for the first time in the English NHS to prevent a merger between two hospital trusts on the basis that it would damage patients’ interests by eliminating competition and choice. At the same time, senior healthcare professionals and managers are warning that hospital closures are essential if the NHS is to continue to offer high quality care to all. This article examines whether market principles encourage or deter the equitable provision of hospital services in England as consumer rights are increasingly upheld in law. It also considers the difficulties of persuading service users that service reconfiguration will be of benefit having been promised greater choice and personalisation of care.