Surrey GP, Dr Michael Bosch, examines the possible fate of patient choice in the wake of the 2010 White Paper; Equity and Excellence: Liberating the NHS.
Introducing market reforms in the NHS is nothing new. Over the last two decades politicians have tried to make the NHS more efficient through an ‘internal’, ‘managed’ or ‘liberated’ market. It was the NHS Plan of 2002 that first introduced ‘Patient choice’ as part of these market reforms. Patient choice was meant to be a key initiative for reforming the NHS.
Patient Choice and its flagship scheme Choose & Book have introduced some useful changes to everyday NHS general practice. Some GPs have come to like features of Choose & Book and it seems likely that Choose & Book can avoid the fate of its fellow flagship initiative NHS Direct and survive the current reorganisation cull. I would suggest that the booking element of Choose & Book is more useful than the ‘choosing’. It is very attractive to send a referral and get the patient to book their appointment directly, although the Achilles heel of that is of course the efficiency of the Central Booking Office at SASH. Choose & Book can also provide data about referrals that is important for planning and commissioning.
There have been some serious problems for patient choice. Not only is there a lack of reliable unbiased information available to GPs and their patients to act as the discerning consumer, but there is frequently no reasonable alternative service. For choice in a market to be meaningful there has to be spare capacity. If this spare capacity has not been there in the seven fat years since the NHS Plan, its lack is quite likely to sound the death knell for patient choice in this new ‘age of austerity’.
The attempt to create more choice and stimulate the market by introducing an ‘any willing provider’ scheme is not likely to solve the problem as it becomes increasingly risky to provide in a market where the commissioners have less and less money to spend.
So, should we upset about the demise of choice? I speculate that most people would be willing to sacrifice patient choice when the survival of a comprehensive, publicly funded health care system is at stake. Not having a choice whether you have your skin lesion removed in Croydon or in Horsham, doesn’t mean however those patients just have to take what they are given. Even in an age of austerity there is a lot of money to be spent on health care and there is a lot to be said for more transparent and responsive re-design of services: Patients and the public should not just let the ‘experts’ like GPs & managers decide what local services should be chosen to continue and which should stop. It might be much easier to explain why there is no choice in certain areas, if the public has had a say in which services have been scrapped. The sticking point here of course, is that patients are never too likely to choose for a service to go. The people a local NHS serves could also choose to strengthen some services and while the debates around what services stay, are expanded or are removed, are likely to be very difficult- even fraught- I suggest that is in the nature of choice.
The White Paper is trying to put budget decisions back to local areas and within ESyDoc’s area there are going to be many choices to be made- and soon. Most of these choices will be painful and hard, but it’s probably better to have a method of cutting and shifting the money that has gone through some democratic and local choice than having a fairly indiscriminate ‘slash and burn’ approach.
