Patient choice is not key to improving NHS performance, the health secretary has declared, in a major break from a policy favoured by Conservative and Labour governments over the past 12 years.

Jeremy Hunt added he did not believe “the market will ever be able to deliver” in the top priority area of integrated out of hospital care. The health secretary’s views on improvement were outlined in a wide ranging interview with HSJ in which he set out his response to the NHS Five Year Forward View vision, published independently by the service last month.

Mr Hunt said choice was not the main driver of performance improvement, contrary to the emphasis placed on it by various governments and senior NHS leaders since the early 2000s.

He said he recognised “there are natural monopolies in healthcare, where patient choice is never going to drive change”.

The health secretary pointed to patients’ “loyalty to hospitals”, even when there are well reported care failings. He gave the example of Kent’s Medway Hospital, which is in regulatory special measures.

Mr Hunt said choice was particularly irrelevant in emergency care and that market forces would not create good integrated community care - one of the service’s main priorities.

Jeremy Hunt

Choice is not the main driver of performance improvement, says Jeremy Hunt

The health secretary gave the example of an integrated care package for a 90-year-old man, with early onset Alzheimer’s and diabetes. Such a patient would need a “bundle of services” and someone with whom “the buck” stopped, ensuring he received the care and support necessary to keep him out of hospital. “That’s something where I don’t think the market will ever be able to deliver,” Mr Hunt said. “That’s why you need to have proper information [and] peer review.”

He said choice was working for some services and predicted it “will be particularly important when it comes to things like residential care - people choosing a care home for their grandparents”.

“Once we’ve got [Care Quality Commission] ratings for care homes, it will have massive impact, and there will be a massive commercial imperative [to achieve good ratings]”.

But, overall, the health secretary emphasised that transparency about quality using CQC ratings and other data would instead drive improvement. This is because it led to “very strong peer review, and desire to improve” for both organisations and professionals.


The health secretary pointed to “very powerful commissioning” as a more important factor than choice, particularly where integrated services were needed.

He said he wanted to see a regime similar to provider inspection and special measures introduced for commissioners, which would be overseen by NHS England. The health secretary also plans to introduce new metrics for assessing CCGs and “whole systems”.

Patient level cost data

Mr Hunt named another priority as ensuring commissioners had patient level cost data.

“You can’t commission smartly unless you know the whole cost that a patient represents to the health and social care system,” he added. “At the moment CCGs don’t collect that data.”

Asked about the regulatory barriers often cited by commissioners, Mr Hunt said: “We are actively working to [address access problems] at the moment. I’m identifying it as a very, very serious issue that we need to resolve and I don’t pretend there isn’t a job for government.”

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