Patient Choice
Last Updated: March, 2019

Increasing patient choice has been one of the smokescreens used by politicians from Margaret Thatcher onwards for the their 'reforms', which have in reality all been about  privatisation  of the NHS.

Most patients want a good quality, local and responsive NHS to treat them for their general ailments when necessary. The principle of a high quality district hospital close to home is one that is cherished by most people in the UK. A 2010 survey showed that the overwhelming majority of people value fairness in public services first, and care about choice and personalisation last. Marianna Fotaki (Professor of Business Ethics at Warwick Business School) said:

...as citizens and users of the NHS, patients are more concerned about retaining the public and universal aspects of their health system than having a choice over the providers of their care.

The genuine patient choice that existed in the first decades of the NHS has been eroded by 30 years of changes purporting to promote choice. Originally doctors could refer patients anywhere and to any other doctor working in the NHS. With the introduction of the market, such referrals are increasingly tied to the contracts that  Clinical Commissioning Groups  enter into. A clear example of this appeared in the Guardian newspaper in 2013:

Following a disastrous A&E experience at Hitchingbrooke Hospital (and our closest A&E at Kettering being under a 'black notice' due to staff shortages), we ended up at Bury St Edmunds A&E who diagnosed my partner as requiring surgery on her knee. We arranged through the consultant at Bury for the surgery to be carried out at Addenbrookes by a surgeon who had already performed similar surgery on my partner's son with spectacular success. All well and good until we were summoned by a GP at a [Northamptonshire] Practice... where we were told in no uncertain terms that the operation would be carried out by a surgeon a Milton Keynes who is not even a specialist in this area. The reason given - 'this is who my contract is with'. When we then questioned what would happen if we went to the Addenbrookes anyway, we were told we would have to fund the surgery ourselves. He delivered this information with a poster headed 'NHS Choices' taped to the wall behind him.

In 2014  NHS England  was forced to concede that there is a paucity of evidence that choice and competition produce any benefit to patients.

Professor Calum Paton said in a review for CHPI:

Just as markets may not involve choice, choice does not require markets except in the basic sense that plural provision exists. Choice existed from 1948 to 1991, after which the market restricted it.

London GP Johnathon Tomlinson summed up choice:

The reason so many of us who care for patients every day object so strongly to the way patient choice is framed in the NHS reforms, is that patients and their choices are not being treated as ends in themselves, but merely as means to an end; they are to become subservient to the goals of market based competitive health care.