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HSJ100

Can patient choice alone force the changes the service needs?

The advent of the coalition has, of course, brought about a major overhaul of the existing power and influence matrix within the NHS.

However, it’s not just the ministers and special advisers that have changed places in the rankings. With the government committed to less intervention from the centre and the dismantling of whole layers of the organisational architecture, pinpointing future influence was a complex task this year.

One notable change is the rise of journalists and media commentators, who figure more prominently in the list than in previous years. This reflects the media tightrope that will have to be walked in order to keep the public onside throughout a fundamental redrawing of the nation’s healthcare landscape. The power and influence that the public - and the patient - will exert is the hardest factor of all to predict.

The white paper identifies patient choice as the dynamic force for change within the NHS, driving the competitive market. But, evidence suggests that while competition between providers may lead to better outcomes, patient choice may not be sufficiently effective to drive change.

It is not clear that consumers select high quality providers when routine information is made available, although the public (and providers) do respond to the media.

Patient choice will need a voice but will also need to be supplemented with other key levers such as inspection and accreditation, financial incentives for providers and clinical commissioners, and appropriate powers for the regulators.

Choice is one weapon but not a magic bullet.

Steve Kirby, head of healthcare practice, Ernst & Young

Readers' comments (1)

  • The conclusion is absolutely right. Unfortunately, choice is being waved around as an all-saving mantra by too many politicians and commentators, and its ain't necessarily so.

    If you're talking about elective care and long term conditions, then the issue of much better information and patient choice has to be a central plank of any future service profile. No problem with that at all. I've sat with enough patients in EPP and Cancer Support Groups to realise that this is exactly the sort of stuff that is needed for some people.

    However, what I'm seeing on my patch (and colleagues up and down the country are telling me the same) is that the real and major pressures are in A and E and unscheduled care, particularly amongst older people with complex and multiple pathologies. When it comes to these areas, the much vaunted 'choice' agenda just doesn't address the dynamics. Put simply, as a one size fits all solution its too glib and too simplistic.

    Effective demand management is not a straightforward issue of leisurely checking of a brochure or website for outcomes and infection rates et al followed by a relaxed one-to-one with your GP (when I suggested this to my elderly parents, both of whom are unfortunately regular but appropriate users of NHS unscheduled care, they laughed fit to bust). Let's not pretend choice as its being portrayed is the salve for all ills. It isn't.

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