UK. King's Fund report on NHS patient choice

UK

King's Fund report on NHS patient choice

Keywords: Waiting times, Patient choice,Alternative treatment

A new King's Fund discussion paper, What is the Real Cost of More Patient Choice?, says that the Government's commitment to extending patient choice is helping drive down waiting times and improve efficiency, but could put equal access to health care for equal need, a key objective of the NHS, at risk. Patient choice schemes are enabling patients to have a clear choice of when and where they are treated, as well as putting pressure on health care providers to improve their performance.

The report evaluates how far choice is limited in the NHS, what kinds of choice are possible and desirable, what the benefits and costs of improving patient choice are, and whether government efforts to promote choice will be successful. It also examines one of the two patient choice schemes currently running in England in which patients waiting more than six months for heart surgery are being offered quicker treatment elsewhere in the NHS, in the private sector or even abroad. The second scheme is in London, where from June all patients waiting six months are being offered this choice.

The authors of the report argue that current patient choice initiatives are motivated as much by the desire to reduce waiting times and improve efficiency as by the objective of improving choice. They urge the Government to ensure that increased patient choice is not promoted at the expense of equity, particularly where there are market failures and capacity constraints.

King's Fund chief economist John Appleby, one of the authors, said: "All health care systems restrict patient choice – not just the NHS. But there is an irreconcilable conflict in the NHS between allowing individual patients unconstrained choice of treatments that are free at the point of use, and the allocation of resources in a cost-effective manner. The wider policy framework surrounding choice is poorly developed at present and the Government has failed to place equity at the heart of its concerns.

"While increased patient choice may exert pressure on poorly performing providers to improve their services, there is no reason to think that this will ensure the equal treatment of those in equal need. An added danger is that some hospitals will see their workload and, importantly, their income reduce as patients choose other hospitals."

Further information: The report, What is the Real Cost of More Patient Choice?, by John Appleby, Anthony Harrison and Nancy Devlin, can be downloaded from the King's Fund Web site at: www.kingsfund.org/publications