Patients choice was formally implemented by the NHS on 1 January 2006.
The idea was based on the contents of the NHS Plan (2000), after which a White Paper, Building on the Best, was presented to parliament by the former Health Secretary, John Reid, in 2003. As well as changes to improve access to services it stresses greater patient involvement in deciding how, where and when they are treated. For instance, by making it easier to see a GP after working hours; or now being able to register with a GP practice near your workplace. Private healthcare firms will be invited to set up a string of fast-track diagnostic centres – a process which is already well in train. Private sector providers are "likely to be part of larger organisations with managerial support". A financial system called “payment by results” follows the patient to the hospital where they choose to go. In other words, if the patient decides to go to hospital X rather than hospital Y then hospital Y will get more money. Opponents of the scheme fear that it will lead to competition that will drive weak hospitals out of business. This sounds suspiciously like the Thatcher government’s plan for the NHS internal market.
Problems of patient choice:
1. it will be difficult to balance the principle of individualised choice about where to go for treatment against the need to sustain services for a the majority of patients (ie those who can’t exercise a choice for example because of a lack of private transport, unavailability of public transport access, poor financial situation etc)
2. people really want good quality health services close to home rather than having to travel possibly some distance in order to get it.
3. more choice exists in cities where a more hospitals can be found and transport is available, than in rural areas where there van be a big distance to the next hospital. For example, during a pilot study of this project, 71% of patients living in London exercised choice; whereas in rural areas this percentage was only 48%.
4. the articulate middle classes with the confidence to challenge their doctors and the ability and resources to travel for treatment will gain more than poorer people.
5. linking choice in public services with "diversity of provision" (that is, with private provision) looks like creeping privatisation of the NHS
6. Bernard Ribeiro, president of the Royal College of Surgeons, described patients choice as ‘Stalinist’, arguing that it will destroy the professionalism of the NHS and put the care of people at risk. The computer system which is intended to allow doctors to talk to each other about patients is superficial, inefficient and impersonal. It is a symptom of the government’s preoccupation with targets and things where ideas look good, but the resources to ensure they are effective are not provided. Ribeiro argued that trying to implement Patients Choice using this computer system destroys personal working relationships between professionals.
7. patients will be given a choice of four hospitals for their first outpatient appointment.
8. however once they get to see a consultant of their choice, the consultant is given only 15 minutes to see them due to the target-led nature of Patients Choice.
The Kings Fund published a report in December 2005 which showed that there is a significant gap (which will adversely affect how Patients Choice works in practice) between the choice that people want and what the NHS is able to deliver. Patients Choice could therefore increase the gap between the access to healthcare by the healthy and wealthy, the middle classes and the better educated and the remainder of the population. Those who are most in favour of Patients Choice are the more frequent users of the NHS (women and older people); and those less in favour are infrequent users such as men and young people.
Those hospitals which attract patients and therefore their money, will be able to perform more successfully than those who do not. This may mean that most money will find its way to large city hospitals and away from rural facilities. This may in turn mean that rural facilities will close because they will lack the resources to attract (or even offer care to) patients; so restricting choice even further.
Why was it done?:
- It meets one of Tony Blair’s main pledges for more consumer choice in the public services
- it is a way of privatising the NHS by stealth
Appleby, J. and Alvarez-Rosate, A. (2005), Who wants patient choice?,
http://www.kingsfund.org.uk/news/articles/who_wants.html;
Carver, J. and Henke, D. (2005), Patients now have wider choice of hospital, The Guardian, 2 January, http://www.guardian.co.uk/uk_news/story/0,,1676500,00.html;
Revil, J (2005), Top surgeon: NHS reforms are Stalinist, The Observer, 1 January,
http://www.guardian.co.uk/medicine/story/0,,1676170,00.html;
Shifrin, T (2003), Q&A: patient choice, The Guardian, 9 December,
http://society.guardian.co.uk/nhsplan/comment/0,8005,1103300,00.html.
