06 June 2003
The government's patient choice scheme risks increasing inequality in the NHS, the King's Fund warned this week.
Its report, What is the real cost of more patient choice?, said extending patients' rights to choose where and when they are treated, including private and overseas hospitals, was helping to drive down waiting lists and improve efficiency.
But it added that giving patients choices risked removing one of the health service's key principles – equal access to care for equal need.
King's Fund chief economist John Appleby said: 'There is an irreconcilable conflict in the NHS between allowing individual patients unconstrained choice of treatments that are free at the point of use, and the allocation of resources in a cost-effective manner. The wider policy framework surrounding choice is poorly developed at present and the government has failed to place equity at the heart of its concerns.'
Appleby, one of the report's authors, added that increased patient choice may exert pressure on poorly performing NHS hospitals to improve their services – they will lose income if their patients go elsewhere. But there was no reason to believe this would ensure equal access for poorer, less-educated or elderly patients.
Pilot choice schemes operating across England must be evaluated to assess their impact on equity, he said.
'We need to know why some people decide against accepting offers of faster treatment with alternative providers, and whether or not these decisions are related to factors such as income, power and education. Why are some patients prepared to travel long distances for faster treatment when others are not?' he asked.
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