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].