Choice extended to all hospitals in England

20 Mar 2008

Patients having non-emergency treatment in England will be able to choose from any hospital in the country as of 1 April, the Department of Health has announced.

From the beginning of April any patient receiving routine elective treatment will be able to choose from any NHS approved hospital provider in England, under a new system called ‘Free Choice’.

In a statement the DH said: “Free Choice makes it increasingly important for providers to have a good understanding of the needs and wants of patients and GPs. Empowered patients are more likely to take greater responsibility for their care and treatment and have a better experience of it.

“With more hospitals and clinics to choose from, providers may also wish to make more information about their services available to patients in order to help them make these choices.”

Under ‘Free Choice’, money will follow the patient and hospitals are paid a tariff rate for each person treated. The DH says this will be a strong incentive to provide good quality services and promote them to patients and GPs appropriately.

Minister for health services Ben Bradshaw, added: “Choice is fundamental to the delivery of a personalised NHS. People would like to have more control and be more involved in the decisions about their illness and treatment. More choice will also help drive up quality and standards across the NHS.”

Patients are currently offered a choice of around five local hospitals and a range of independent sector treatments centres and private hospitals on an approved list that offer operations at NHS cost.

One patient, Jack Lester, said: “Choice was important for my wife and I as it meant we had an option on local hospitals. We were able to choose the one which could see us soonest and was still close to home. The standards of treatment and attention were very high, gave us peace of mind and made a real difference.”

In a bid to aid patients exercise their right to ‘Free Choice’, NHS Trusts and organisations providing health care funded by the NHS, will be able to promote their services to patients for the first time.

The DH says: “Patients and their GPs will need reliable, accurate information on which to make choices for their health care needs and promotional activity will help to make this information easily available - along with other sources - such as the NHS Choices website and information in libraries and GP surgeries.”

Advertising and promotional activity will be regulated by a new code of practice, which seeks to achieve a balance between the needs of patients, health professionals and the public.

A series of NHS branded advertisements will also run in regional newspapers and regional radio, designed to raise awareness of choice and to help patients make informed decisions about their choice of provider.

Anthony Halperin, of the Patients Association, welcomed the plans, but added: “In theory it sounds good, but in truth patients just want to go to their nearest hospital. They often do not have time or the inclination to compare hospitals and consultants and travel constraints mean if they wanted to it is not always possible.”

Link

Department of Health

Joe Fernandez

Reader's Comments

Who pays for the hidden costs?

20 Mar 08 12:40

Non-mobile patient that requires a hip replacement and happens to live in Truro elects to be seen in London. Who's pays for the transport & accomodation? Patient, Trust or PCT?

Looks like a good idea But....

25 Mar 08 21:48

So now a chunk of the NHS budget is going to be spent on advertising. Another nail in the coffin of the NHS? The old style NHS and its ethos that treated patients according to clinical need may have had some problems but you could be reasonably sure that there was no profit motive behind your doctors judgement. Will expensive glossy advertising really treat more patients and can we be sure that pressure will not be exerted on staff to carry out only the most profitable procedures?

Shocked

26 Mar 08 22:27

As an understanding tax payer and occasional patient - I am a bit shocked by the comments in this article and the article itself.

As a patient - I am interested in being provided with as much information possible regarding the quality of care available from different NHS providers - I am also a bit surprised by a statement that states - I would always choose the closest hospital!

As a patient I would like to be seen at hospital which can provide me the best service with clinical staff with the best skills – also it is very important that the care I receive is in clean environment which would make me feel comfortable - I really do not care if that is a few miles away and if not the closest hospital – I care about my health and would make sure I have the time ensure that I get the best treatment in the cleanest hospital available.

It may be a very basic view but a local but dirty hospital would not be my first choice - compared to a clean hospital that is a bit more distance for me to travel - I want to be well and hospital with a history of being dirty would not give me confidence.

Just an observation - you'll probably ignore me - something like I don’t understand the difference between a good hospital or a bad one – I guess that’s why the advertising is going to happen – so I know who is good and who is not – as a tax payer and patient I really do want to know and if dirty hospitals need to close cause no one chooses to goes there – I really wont care because I wont be there!

Free to choose?

27 Mar 08 13:37

Our 'shocked' correspondent has touched on one of the deep flaws in the Choices agenda. They say they want the choice to travel to a different hospital if that means they can go somewhere that's clean and efficient, where the clinical standards are best, etc. Superficially this might seem reasonable. and some might believe that market mechanisms can be harnessed to help drive up standards.

But to make this work equitably, other critical ingredients are required. Things like the flexibility to take time off work, money to pay for travel and accommodation, access to comparative information (rather than marketing spin) and the ability to understand and use it. In general terms, these are all things that poorer people have less of. You also need some excess capacity in the system, which is something that no Government is willing to pay for,

Because capacity is limited and people cannot exercise choice equally, the most likely outcome is that poor people will be forced to accept a poorer quality of care. The Government will be able to hide behind the excuse that people had a free choice, and some just exercised this unwisely.

As with so many of the Government's 'good ideas' Choices is likely to exaggerate inequalities and entrench poverty and poor health.

NHS pseudo-choice

27 Mar 08 15:05

The NHS choice agenda is the conception of the political classes domiciled in SW1 or (perish the thought) roughing it in Kensington or Islington.

District General Hospital closures of the last 20 years mean those outside of London Zone 1 often find their nearest facilities 20 miles plus away - or over an hour in traffic.

Furthermore the majority of hospital admissions are of very sick or infirm people in emergencies or at short notice. They don't want choice or simply are incapable of exercising it!

The choice agenda assumes the patient is middle aged, middle class and in full possession of both mental and transport faculties with a slightly irritating but non-urgent condition (e.g. varicose veins) that he (his (yes it's a man too) wants dealt with at their total convenience (see weekend and evening surgeries etc).

Most patients in most circumstances have no 'choice' - it's their (most-)local hospital if they're lucky - or a sixty mile ambulance trip to the next when they're not.

The other corrosive fallacy of the choice agenda is that the quality of an hospital is easily measured - or indeed sensibly quantifyable at all.

There are differences between individual wards, clinics, departments and professionals within one organisation. Each patient's unique and unpredictable path through the system might lead them to encounter the good, the bad or the indifferent side of an institution regardless of its star rating.

I am a doctor now working in healthcare informatics - yet when I or my relatives need help (urgently or otherwise) I can conceive of no statistic that would inform me better than the counsel of a local GP who knows me well. I also do not want to go anywhere except the nearest facility with well resourced professionals enabled to do their best (i.e. administered NOT 'managed' in contemporary speak)

Meanwhile money is thrown at measuring and chasing vacuous targets and window-dressing measures such as the risible 'deep cleans'. This erodes professional morale as well as squandering more tangible resources.

NHS pseudo-choice? Just say no!

Declaration of interest - I worked 15 years in the NHS and remain intimately familiar with its workings. I am a fairly healthy middle class man living in London SW6.

Choice is a sham

27 Mar 08 20:50

If a hospital waiting time exceeds government targets you are not allowed to choose it. So "choice" can prevent you going where you want. Furthermore, the "money follows the patient" idea is ignored in practice - for instance our main Primary Care Trust won't pay for more than the lowest quartile of follow-up frequency for each specialty - a bit like shooting anyone worse than average - recursively.

Who really chooses ?

30 Mar 08 22:00

Choice of hospital, like choice of school is not really for citizens. PCTs mould choices, increasingly replaced with Practice Based Commissioning consortia - and that is really scary - do I send you to an expensive hospital or put the money in my own pocket and treat you in the surgery. Hmn, I'd advise you stay here.

Outside London, the transport costs of exercising choice are significant, and the impact on the environment of all this excess travel. Many of us are lucky to have buses running to our most local hospital, only those with cars are likely to be in a position to roam further.

And I would not trust the advertising by Foundation Trusts either.