DH unveils plans for increased competition in diagnostics and mental health

In a public consultation document, the DH outlined its priorities for extending patient choice “at all stages of care and treatment, irrespective of a patient’s clinical pathway and their progress along it”.

It reiterated its commitment to “go beyond” patient’s current rights to choose, and “extend the principle of choice of any qualified provider from across the public, private and third sector to other areas of healthcare”.

The right to choice of first outpatient appointments for acute elective care was introduced in April 2008. In the following three years NHS spending on private acute care grew by more than £300m, from £614m in 2007 to £957m in 2010, according to analysts Laing & Buisson.

For “too long”, the consultation stated, this choice had not been available to patients referred for secondary mental health care. “We want there to be parity for users of mental health services with those receiving other forms of elective care, where possible,” it said.

To begin this process, it has proposed giving all service users the choice of any named consultant-led team within their secondary mental health provider by April 2013. By the same deadline, it suggested this choice should also be available for mental health services run by other professionals, such as psychiatric nurses, occupational therapists or clinical psychologists.

Beyond this, it said the DH had commissioned a study assessing barriers to providers moving into – or within - the market for NHS-funded mental health provision.

It acknowledged there were “some barriers” to extending patient choice in mental healthcare, highlighting the need for some services to be integrated with social care, and “insufficiently developed” mechanisms for pricing services under NHS payment by results.

However, it said commissioners “should be thinking of ways of ensuring that mental health service users have the same choices as those for other elective care services”. It proposed “challenging commissioners to pilot and test new ways of extending shared decision making, including through greater use of the any qualified provider model from 2013-14”.

AQP would also be a “key mechanism for giving patients a choice of diagnostic test provider in the community”.

In future, it stated, diagnostic tests not carried out as part of a consultant-led first outpatient appointment should be listed on the Choose and Book IT system, which currently enables patients to choose their provider for elective care.

The DH said it would set out the priority tests for “comprehensive inclusion” on the system during 2012-13. It suggested these could include electrocardiograms (ECGs), non-obstetric ultrasound, gastroscopy and audiology.

Some commissioners have already chosen diagnostic services as a priority for the extension of AQP, under the government programme that requires some community services to be opened up to increased competition this financial year. The DH expected this would be focussed on magnetic resonance imaging and non-obstetric ultrasound “in the first instance”.

However, it added: “We want the presumption to be that patients going for diagnostic tests in the community would have a choice over their test provider and we will continue to support the expansion of any qualified provider for diagnostic services… from 2013-14 and beyond”.  

During this year the DH intends to “explore the possibility” of extending choice of diagnostic test provider to “other points along the patient pathway” for example “in secondary care and aftercare”.

The document also lists the “levers” the DH might use to “give effect to changes or extensions to choice policy”. These included: regulations, imposing “legal requirements for the NHS Commissioning Board and clinical commissioning groups”; the standard NHS contract, requiring providers to list all services eligible for competition on Choose and Book; and the “choice mandate” the health secretary will publish for the NHS CB.

This document, it said, would set out specific government proposals to increase patient choice; where there were “no specific proposals” it would be asking commissioners to develop their own.

It added that patients’ right, under the NHS constitution, to choice of any qualified provider for elective care could be “extended over time”. Mental health services and urgent referrals are currently exempt from the right.