Back to the future? Lessons on the pro-competitive regulation of health services

The enactment of the Health and Social Care Act 2012 can be seen as a ‘paradigm-oriented’ policy transfer of the model of utilities regulation in the UK. This article draws on the literature on infrastructure regulation in order to analyse this transfer. Taking a long view on attempts to introduce competition into health services in England, it points to a number of challenges of liberalisation, corresponding to those arising in infrastructure sectors. Using a framework drawn from utilities, it analyses these under the headings of: (a) market structure; (b) allocation of regulatory authority; and (c) decision-making style. It suggests that the lens of utilities regulation is a useful one for analysing the NHS reforms, and clearly shows the difficulty in establishing workable competition in the sector.