Published: 07/10/2004, Volume II4, No. 5926 Page 10 11

Ministers put the Department of Health under pressure to roll out patient choice ahead of current deadlines, an HSJ conference heard last week.

At the conference, DoH director of access Margaret Edwards discussed the challenges of meeting deadlines to offer most patients a choice of four or five hospitals by December 2005 and of any provider meeting NHS standards by 2008.

She said she had resisted pressure from ministers to speed up these changes. 'We were under pressure to do things earlier but It is my job to advise ministers on a realistic timetable for the way that it could be done.'

Ms Edwards said the programme was already showing results. 'Choice at the end of a sixmonth wait has already seen a 30,000 reduction in the number of people waiting over six months at the end of March 2004, but it can only work if primary and secondary care work hand in hand.'

Speakers discussed the implications of the choice agenda on the way the NHS operates. Chief executive of Salford Royal Hospitals trust David Dalton said the programme would encourage hospitals to adopt aggressive marketing techniques.

While trusts would stop short of actively advertising for business, they would have to develop sophisticated marketing departments to attract and secure business from patients, he predicted.

Mr Dalton said that patient choice would not only redraw the relationship between primary care trusts and a future all-foundation trust NHS but also between those trusts and their patients.

Asked if foundation trusts would resort to direct advertising, he said: 'They are unlikely to go that far. But marketing departments already exist and they will have to develop, as we will have to design services that meet the express needs of customers or users. Marketing will become much more sophisticated.'

He said foundation trusts would have to adopt a predatory approach to keeping patients: 'There is no doubt that I would have my eye on influencing people to exercise their choice in favour of my organisation. I would be going over the head of the patient choice adviser and contacting the patient directly via the marketing department.'

Mr Dalton said this approach went to the heart of the ethos of foundation trusts, creating what their champion, former health secretary Alan Milburn, called 'social capital'. Mr Dalton described this as 'doing things with people, rather than to them'.

And he said this new aggressive marketing approach was essential as the private sector, which had had to come to terms with tight pricing to win NHS contracts, was also looking to new markets.

'There are lots of new companies looking at primary care markets - providing and commissioning on behalf of patients.'

Rotherham PCT chief executive John McIvor was concerned about the London-centric nature of the patient choice pilot projects.

'It was interesting that the pilots all centred on London, where the ability for people to move around is much more flexible because of public transport links. Therefore building choice around such a project could be flawed and should be taken with a pinch of salt.'

Mr McIvor said that people in South Yorkshire 'do not travel' and gave the example of patients reluctant to travel 15 miles to Mansfield for care.