NHS patient choice scheme has benefits but must not jeopardise equity, warns The King's Fund

The government's commitment to extending patient choice is helping drive down waiting times and improve efficiency, but could put at risk a key objective of the NHS – equal access to health care for equal need, according to a King's Fund discussion paper published today.

What is the Real Cost of More Patient Choice?, by John Appleby, Anthony Harrison and Nancy Devlin, says 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 discussion paper argues 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. It urges 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.

The King's Fund chief economist John Appleby 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.'

The discussion paper looks at 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.

John Appleby added:

'The pilot patient choice schemes must be rigorously evaluated to assess their impact on equity of access to health services. We need to know why some people decide against accepting offers of faster treatment with alternative providers, and whether or not these decisions are related to factors such as income, power and education. Why are some patients prepared to travel long distances for faster treatment when others are not?'

Read the report: What is the Real Cost of More Patient Choice?

Notes to editors: 

1. What is the Real Cost of More Patient Choice?, by John Appleby, Anthony Harrison and Nancy Devlin, is free to download from our publications section. Printed copies are available from King's Fund publications on 020 7307 2591, price £6.50.

2. The discussion paper is part of a series of publications from The King's Fund's Shaping the New NHS programme. Can Market Forces be Used for Good? was published on Monday May 19 2003. Further papers will be published throughout 2003 on: 

  • Is there a role for an 'arms-length' NHS agency?
  • How will growing demands on chronic care be managed?

3. There are currently two patient choice schemes running in England. Firstly, 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. Secondly, in London, patients from selected specialities also waiting around six months have been offered a similar choice of quicker treatment. By June 2003, all patients in London waiting six months will be offered this choice. The King's Fund is one of a number of collaborators charged with evaluating the London patient choice project.

4. For a review copy of What is the Real Cost of More Patient Choice?, or for further information, please contact Daniel Reynolds in the public affairs office on 020 7307 2581 or 07831 554927, or Helen Evans on 020 7307 2632 or 07774 218439.