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Competition and choice

Published online by Cambridge University Press:  02 January 2018

Simon P. Wilson*
Affiliation:
Oxleas NHS Foundation Trust, email: simon.wilson@kcl.ac.uk
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Abstract

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Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2012

Sugarman's commentary Reference Sugarman1 strikes me as rather missing the point. I did not take Mynors-Wallis Reference Mynors-Wallis2 to be criticising practitioners working outside of the National Health Service, but instead to be looking critically at the evidence that competition is the best mechanism for improving care. Sugarman makes much of the value of patient choice in improving services, although does not cite any evidence in favour of this assertion. In many mental health settings, this is also disingenuous. Our patients do not have any choice, instead it is the primary care trusts (PCTs) who make choices on their behalf. Even with the most benign possible view of these arrangements it is hard to believe that PCTs make their decisions on the basis of the wishes of the patients or their families as their primary concern. It may be that PCTs are, in fact, fantastically good at choosing the best, highest-quality, and most cost-efficient healthcare, but let us not pretend it is about patient choice.

References

1 Sugarman, P. Diversity and choice in mental healthcare. Commentary on … Cooperation or competition? Psychiatrist 2011; 35: 443–4.CrossRefGoogle Scholar
2 Mynors-Wallis, L. Cooperation or competition? Proposed changes in healthcare provision in England. Psychiatrist 2011; 35: 441–3.CrossRefGoogle Scholar
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