Jon Glasby: reply to editorial Guus Schrijvers December 2007

Professor Schrijvers’s editorial raises some important challenges for everyone interested in integrated care. It also strikes a particular chord here in the UK (or at least in England), where a series of recent reforms have begun to introduce greater elements of choice and competition into a system that has often been seen as something of a public sector monopoly. However, many UK commentators have struggled to think through how best to combine competition and collaboration—especially when you may need to do both at the same time! For example, some people would feel that greater competition is an important incentive when it comes to elective care, encouraging hospitals to keep their waiting times to a minimum and improve the quality of their care. However, the same hospitals that are competing for elective patients might also need to collaborate with each other to ensure that there is an appropriate mix of local minor injury units and regional specialist services to meet the needs of emergency patients. Similarly, current policy is encouraging health and social care providers to integrate their services, yet this runs the risk of creating a local monopoly and thus undermining choice and competition.