02 July 2004
Last week's row over which party would offer patients genuine choice of where and when they are treated in hospital left NHS managers bemused. Few believe the mantra of choice is the key to transforming the health service.
As one NHS trust chief executive puts it: 'Patient Choice or Right to Choose is the icing on the cake. Extra capacity is the sponge.'
The 'sponge' is so crucial as it is the means to deliver the government's ambitious new waiting-time target set out in last week's NHS Improvement Plan. By 2008 no patient should wait longer than 18 weeks for hospital treatment.
Crucially, waiting times will now be measured from the time the patient is referred by their GP, not from when they are put on a waiting list by a consultant, as at present. This will not be easy.
Conceivably, choice could increase capacity by drawing in a range of new private providers eager to capitalise on the new waiting-time targets – some would argue it is already doing so.
But this is not a chicken and egg situation. Capacity must come first if waiting times are to come down and choice is to be offered. Extra capacity means more doctors, more nurses and, especially, more diagnostic staff like radiographers and medical scientists.
Currently, the average waiting time from GP consultation to treatment is 30 weeks, so the NHS will have to cut 12 weeks (time now spent on diagnosis and waiting to join the list) off the average time to meet the 18-week target.
Health Secretary John Reid assured the NHS Confederation conference on June 24 that the 18-week wait could be achieved and that the Department of Health had run simulations to prove this. 'By 2008 the average wait from GP referral to treatment will be ten weeks. That is now within the reach of the British NHS. And when you get there the question will not be how soon but how good.'
Expanding diagnostic capacity will mean even more NHS and independent diagnostic and treatment centres. Eighty are due to be up and running by next year and King's Fund chief executive Niall Dickson says 'heavy investment' in such units is imperative.
'Ministers cannot wave a magic wand for this to happen and will need to invest heavily in diagnostics, recruit more doctors, nurses and allied health professionals and increase use of the independent sector,' he adds.
NHS Confederation chief executive Gill Morgan agrees that while the targets are challenging, they can be achieved. 'Delivering the targets will require new ways of working, better IT and the best use of all the capacity available, whether in the public, voluntary or private sector,' she says.
The 18-week target will be one of the few national targets set for the NHS in England over the next three years. NHS chief executive Sir Nigel Crisp told the NHS Confederation conference that the planning and priorities guidance due to be published in late July would set a handful of national targets on health outcomes and outputs. It would ask for local targets to be set against five principles, including local population needs.
For now, though, the debate over choice rumbles on. This week, British Medical Association chair James Johnson warned that the government could quickly lose control of the health care market it had fostered.
'John Reid reassures us that the amount of health care provided to the NHS from the private sector will not grow to more than 10%–15% of the total NHS output,' he said. 'But he may underestimate the speed at which markets can react when lucrative opportunities present themselves – and the NHS will be a £100bn market in three or four years' time.'
With such spending power, the health service should be able to increase the capacity available to it and, in doing so, ensure a broad choice is offered. If so, patients will be able to have their cake (with icing) and eat it.
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