• NHS England director of personalised care told HSJ choice of provider remained “fundamental”, despite competition curbs
  • Regulator will “keep a watch” on integration models to ensure legal right to choice is maintained
  • Suggests government departments pool budgets to improve voluntary sector funding

Choice of provider remains “fundamental” and integrated care systems will “fail” if they do not offer it, according to a senior NHS England director. 

The comments by the organisation’s director of personalised care James Sanderson to HSJ come amid proposals for curbing competition in the NHS, and concerns from some that this will also constrain patients’ choice.

However, in a wide-ranging interview, Mr Sanderson said enforcing people’s current legal right to choose their provider was essential to proposals for “universal” personalised care in the NHS long-term plan.

He said: “People have come to expect the same sort of choice and control over their health care as they have come to expect in every other part of their life. There is an absolute imperative that we are meeting that expectation change in society.”

He said the existing legal right to choice was “fundamental” to plans for more personalised care, adding: “[If you are] giving patients the opportunity to make informed decisions about their care and treatment, you have to follow through with giving them the mechanism of exercising that choice.”

Mr Sanderson dismissed concerns that the creation of ICS – in which NHS commissioners and providers work closely together with a common financial interest – could lead to reductions in choice.

“Somebody may want to take their elective care outside of their local area but it is highly unlikely to lead to the collapse of the system because you’ll have people conversely having the choice to move into that area,” he said.

However, Mr Sanderson said there may need to be “different mechanisms in the future” to promote patient choice under new models such as tendering more extensive and longer contracts with a single provider; and that “we have to keep a watch” to ensure choice is protected.

He continued: “We know that one size fits all doesn’t work. We know that you are not going to meet the needs of all your population, so why start off on the basis of commissioning services that don’t have a choice in there as you [would be] commissioning to fail.”

The most recent national adult inpatient survey, in 2017, found just 27 per cent said they were offered a choice of hospital when they were referred. The highest result on this question was in 2010 at 31 per cent. In 2017, 10 per cent said they were not offered a choice and they would have liked one, while 63 per cent said they were not but they did not mind. NHS England has highlighted a voluntary survey of people who use the online booking service of the e-referral system, in which around 74 per cent said they “feel [they] were able to make choices that met your needs”.

Mr Sanderson said NHS England’s universal personalised care proposals, which aim to embed patient choice and support across the NHS, will be a “massive shift” in how the NHS works (see details in the box below).

He said the NHS long-term plan moved personalised care from a “nice to have [to] one of the five service shifts [needed] for the future of the NHS”. The other four are digital, primary care reform, emergency care, and population health.

Meanwhile, Mr Sanderson said social prescribing by GPs would soon be “legitimised” by new funding for 1,000 social prescribing link workers in primary care networks by 2020-21.

In relation to concerns about funding for the voluntary sector – which is relied on for large elements of the proposals – Mr Sanderson told HSJ there “had to be a conversation across government departments” to try to make it “sustainable”. He suggested pooling resources for the sector across the Department of Work and Pensions, Ministry of Justice, Department for Environment, Food and Rural Affairs, and the Office for Civil Society.

Updated on 16 April at 5.20pm to include reference to the e-referral online booking service.

What is personalised care?

Most clinical commissioning groups have been involved in offering personal health budgets to people who need wheelchairs, and community-based continuing healthcare funding, and those with mental health and learning disability conditions.

The budgets can be used to give people greater choice in how they organise their care or choose their equipment.

The universal personalised care plan incorporates PHBs but also includes proposals in five other areas: shared decision making; personalised care and support planning; the legal right to choice; social prescribing; and self-management.

The six components have very wide-ranging ambitions, including plans to change doctors’ training to include how to decide treatment with patients; and widen PHBs through statute to include five further areas – end of life care, equipment, dementia, carers, and neuromuscular diseases.

The NHS long-term plan said the NHS would deliver personalised care to 2.5 million people by 2023-24.