Competition within publicly funded services such as school education and the NHS is a hard idea to sell. The idea that it might be desirable for publicly funded schools to compete with one another for pupils or NHS hospitals to compete for patients strikes many people as bizarre at best and positively evil at worst. The fear seems to be two fold: that such competition will damage the quality of service, and that the competition will come from the private sector, hence privatising or hollowing out the ‘real’ NHS or public education

The fear of about quality is misplaced, at least in health care. There is now a considerable volume of evidence that increasing competitive pressure does indeed provide the challenge that public services need if they are to improve. Zack Cooper, Carol Propper and colleagues at the London School of Economics and the University of Bristol found that, during the period when patient choice was introduced in England, hospital quality improved faster in more competitive areas. Propper and colleagues have also shown that competition had a positive impact on the quality of management with knock-on effects on hospital quality, while Richard Cookson and colleagues at the University of York have shown that the package of competitive reforms even improved the equity or fairness of service delivery – or at least did not damage it[1].

The worry over competition from the private sector seems to stem from the assumption that every one in the private sector is, in the philosopher David Hume’s terminology, a self-interested ‘knave’ out to exploit the weak and vulnerable. In contrast, all those in the public sector are assumed to be altruistic ‘knights’, whose only concern is with the care of the people they are helping, and whose jobs and institutions must be protected at all costs – even if quality suffers as a result. In fact, of course, not everyone in the public sector is a knight; nor is everyone in the private sector a knave, as GPs and consultants in private practice would attest. In fact, many potential and actual providers from the ‘private’ sector are actually social enterprises of various kinds, who are indeed generally staffed by knights: charities, other voluntary organisations and, of particular current interest from all sides of the political spectrum, ‘mutuals’ or employee-owned enterprises.