comment: If choice is to succeed, the NHS must demonstrate a change in its attitude

Published: 16/09/2004, Volume II4, No. 5923 Page 15

There will be those who believe that the spaceship HSJ has chosen to depict the arrival of choice is packed full of alien invaders intent on capturing NHS patients and whisking them away.

This view of the independent sector is common in the NHS. Some would even argue that it is the flipside of the public sector ethos that motivates so many in the service.

Those who work in the independent sector are equally affronted by this attitude, believing the right to purchase healthcare should not be denied to those with the money to do it.

The result has been a stand-off between the NHS and independent sector with any contact often viewed as a necessary evil. As a result, deals have been short term and expensive.

However, with the government's insistence that 'choice menus' offered to patients must include at least one independent sector choice (news, pages 3-5), the relationship between the NHS and the private sector must mature - and fast.

This week's Big Story (pages 10-13) shows that in places like Manchester and Essex it already has. Here the independent sector is providing care to NHS patients and, apparently, delivering value for money and good patient satisfaction. Not every experience of using the independent sector will be as positive, but the genie is easing its way out of the bottle.

Those who argue against the use of the independent sector say it will either undermine investment in the NHS or leave the system with expensive and inappropriate secondary care capacity once waiting lists fall. Given the current level of investment, the first concern seems unjustified, but the second is a sensible caveat that local health planners should be aware off.

It remains to be seen to what degree the insistence on the inclusion of the independent sector in choice menus is another 'incentive' for the NHS to raise its game. However, it is hard to see how total waits of 18 weeks or choice at the point of referral will be delivered by 2008 without the independent sector playing a much more significant role in specialties such as cataracts and orthopaedics. l