It has been nearly a year since choice at the point of referral to hospital by GP was to be formally offered to all patients. Are the poor now getting the choices that have always been available to the rich (to paraphrase former health secretary John Reid)? And through their choices, are patients exerting pressure on providers to improve the quality of services (to paraphrase Tony Blair)?
The Department of Health has published two surveys of patients carried out for it by Ipsos MORI. The first was conducted in May/June and the second, published in December, covered referrals made in July. The surveys cover 70,000-80,000 people.
Unfortunately, the data collected does not prove either Mr Reid or Mr Blairis assertions about choice, but it does shed light on the extent to which patients can remember being offered choice and their awareness of the policy. There has been some improvement on both these counts, but the data does not look very encouraging, with only about a third of those surveyed saying they had been offered a choice, and a similar proportion being aware of the policy in the first place.
On equity, the surveys do have a bit to say - if not about dimensions such as income or social class. There seem to be some variations in sex, age and ethnic group. For example, women across all age groups are more likely to recall being offered choice than men. And those aged 35-64 are also more likely to recall an offer of choice than others.
There are bigger differences in recall between ethnic groups. Proportionally more white people than other groups remember being offered a choice - with the lowest proportion recalling choice in the latest survey being black.
Geographically, too, there is considerable variation (although with no obvious pattern, such as a relationship with healthcare needs as reflected in the weighted capitation formula). The percentage recalling an offer of choice varies across PCTs, from 71 per cent to just 8 per cent. Although there has been a general improvement nationally between the two surveys on recall, for about one in six PCTs the proportion who remember being offered choice fell from May to July.
The surveys also asked which factors patients found most important in choosing a hospital. Proximity and ease of access topped the list in both surveys. If it is a true indication of what they actually consider, this suggests that a significant number of patients may be somewhat reluctant to play their part in the new economic environment - exerting pressure on providers by, crudely, taking their business elsewhere.
John Appleby is chief economist at the Kingis Fund.