Government could learn from experience of care of people with HIV as it moves to extend patient choice

The treatment and care of people with HIV may shed light on the government's new policy of allowing patients to choose the hospital where they are treated, according to a new King’s Fund report out today.

The report, Where the patient was King?, examines the experiences of patients with HIV and hospital staff at five specialist units in London to explore the government's main rationale for introducing greater choice: that it will lead to better and more responsive patient care.

The report's author interviewed clinical staff including lead consultants and nurses, as well as patients. Questions ranged from those asking about the experiences of patients moving hospitals to how individual units responded to the threat of patients moving. The main findings are:

  • Patients valued the right to choose the place where they were treated although only a minority tended to move between hospitals.
  • The quality of services provided to patients at these units was high - this appears to be the product of motivated professionals, adequate funding and vocal patient groups. But patient choice, including the threat of patients moving hospital, did have a role to play in motivating these units to be more responsive to patients.
  • Certain patients were more likely to exercise their right to choose their place of treatment than others. These included those who were better-educated, more vocal and more mobile.

NHS services for people with HIV developed from the mid 1980s, and allowed patients complete freedom of movement between hospitals. A payment system evolved that linked the money a hospital received to the number of patients seen, in a system similar to the government's current policy of offering a free choice of at least four hospitals or clinics to patients and a payment system allowing money to follow patients.

Report author, The King's Fund health policy fellow, Ruth Thorlby said:

'Services for people with HIV/AIDS evolved in an unusual environment, not least because of the fear and stigma that came with the virus. But this is also one of the few examples of genuine patient choice that the NHS can draw on as it now embarks on a major policy experiment to extend choice of hospital provider. What we know from this research is that giving patients the right to switch hospitals can have a positive impact. It did focus the minds of senior professionals on providing the best care for patients, but was certainly not the only, or even most important, factor in their work.'

She added: 'For the NHS in general, allowing people to vote with their feet if they are ever unhappy with services could galvanise the NHS into becoming more responsive to patient needs.'

The report says a significant challenge to policymakers is to carefully monitor the number and characteristics of patients who choose a particular hospital, as well as assessing how the actions of these patients affect the quality of services in hospitals they have chosen to avoid.

Commenting on the report, The King's Fund chief executive Niall Dickson said:

'This report should be encouraging news for the NHS and the current direction of policy. But it does show that extending patient choice does have some risks. Most of the patients in the study who exercised their right to choose were perceived to be the better educated and more vocal minority.

'If patient choice across the NHS is to be a success we must ensure that all patients, especially the vulnerable, are able to exercise and take advantage of the extra benefits choice can bring.'

Read the report: Where the patient was King?

Notes to editors: 

  1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.