Consumers' organisation raises questions over choice in the NHS
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The collective effect of individual choice carries grave risks, particularly in health care, where "payment by results"—the policy of allowing funding for each patient to follow his or her choice of provider—could lead to restrictions on access, says Which?, the United Kingdom抯 leading consumers?organisation.
It adds that although it remains an advocate of choice it does not think that the choices on offer in key areas, including health care, are "right for consumers or framed in such a way as to meet desirable policy objectives."
The public will have a very limited role in deciding what choices are put before it, the organisation argues, "so there is no guarantee that the choices offered to patients at the end of the process will be the ones from which they want to choose."
It says that the government must create a suitable framework within which choice and competition can operate "fairly and effectively to the benefit of all patients."
This framework should include "policies to ensure that people with the least ability to make choices, who often suffer from poor health, are not further disadvantaged, including targeted information and support and help with practical needs, such as travel costs."
It says the government must properly monitor its policies on choice and their effect on services to ensure that patients receive health care on the basis of clinical need and that people with the poorest health are not left untreated.
It concludes that the government must also measure whether the benefits of greater choice justify the costs and ensure that choice does not redirect resources in such a way that it undermines universal access and quality of care, which is people抯 main concern.
The organisation set out its thinking on the government抯 agenda for choice in four main policy areas, including health care, at a major conference in London last week. Its head of policy, Graham Vidler, told the conference that "choice can be bewildering for so many people, and in practice many try to scale down the choices open to them however they can."
From 2006 primary care trusts will offer patients a choice of four or five local NHS providers, and the choice can include foundation trusts and independent treatment centres.
Niall Dickson, the chief executive of the independent health think tank the King抯 Fund, said the panel of experts who had spoken at the conference were "fairly negative about the government抯 interpretation of the policy." Some had "an apocalyptic view that it could result in fragmented services and the end of a universal health service." Others were more concerned about the thrust of the policy, he added, and that there was "too much emphasis on elective surgery and on the acute sector and the notion that choice is about choice of provider."
The panel believed other issues needed to be considered, such as choice of treatment and style of treatment, the choice whether or not to be treated, and a "screaming need for choice in mental health, but no sign of that yet."
Mr Dickson said one view of the panellists was that the NHS had "lamentably failed in many respects to provide equity, but that this would further undermine it."
The evidence on what happened when patients were offered choice was mixed, he added. Frances Blunden, the principal policy adviser for health at Which?, said that so far the experience of choice was very limited but that "people wanted to decide when and how they accessed services and wanted convenience and continuity of care and to see the same professional time after time." They wanted "good quality local services, and cost and distance are huge barriers," she added.
Allyson Pollock, chairwoman of health policy and health services research at University College London, said the decision to allow foundation trusts to market their own services meant that choice was being linked to greater inefficiency and costs.
Angela Coulter, chief executive of the European branch of the Picker Institute, an organisation that aims to improve the quality of health care, said choice was popular with patients and that the recent piloting of choice in London and for coronary heart disease had "resulted in better, coordinated care."(Ann McGauran)
It adds that although it remains an advocate of choice it does not think that the choices on offer in key areas, including health care, are "right for consumers or framed in such a way as to meet desirable policy objectives."
The public will have a very limited role in deciding what choices are put before it, the organisation argues, "so there is no guarantee that the choices offered to patients at the end of the process will be the ones from which they want to choose."
It says that the government must create a suitable framework within which choice and competition can operate "fairly and effectively to the benefit of all patients."
This framework should include "policies to ensure that people with the least ability to make choices, who often suffer from poor health, are not further disadvantaged, including targeted information and support and help with practical needs, such as travel costs."
It says the government must properly monitor its policies on choice and their effect on services to ensure that patients receive health care on the basis of clinical need and that people with the poorest health are not left untreated.
It concludes that the government must also measure whether the benefits of greater choice justify the costs and ensure that choice does not redirect resources in such a way that it undermines universal access and quality of care, which is people抯 main concern.
The organisation set out its thinking on the government抯 agenda for choice in four main policy areas, including health care, at a major conference in London last week. Its head of policy, Graham Vidler, told the conference that "choice can be bewildering for so many people, and in practice many try to scale down the choices open to them however they can."
From 2006 primary care trusts will offer patients a choice of four or five local NHS providers, and the choice can include foundation trusts and independent treatment centres.
Niall Dickson, the chief executive of the independent health think tank the King抯 Fund, said the panel of experts who had spoken at the conference were "fairly negative about the government抯 interpretation of the policy." Some had "an apocalyptic view that it could result in fragmented services and the end of a universal health service." Others were more concerned about the thrust of the policy, he added, and that there was "too much emphasis on elective surgery and on the acute sector and the notion that choice is about choice of provider."
The panel believed other issues needed to be considered, such as choice of treatment and style of treatment, the choice whether or not to be treated, and a "screaming need for choice in mental health, but no sign of that yet."
Mr Dickson said one view of the panellists was that the NHS had "lamentably failed in many respects to provide equity, but that this would further undermine it."
The evidence on what happened when patients were offered choice was mixed, he added. Frances Blunden, the principal policy adviser for health at Which?, said that so far the experience of choice was very limited but that "people wanted to decide when and how they accessed services and wanted convenience and continuity of care and to see the same professional time after time." They wanted "good quality local services, and cost and distance are huge barriers," she added.
Allyson Pollock, chairwoman of health policy and health services research at University College London, said the decision to allow foundation trusts to market their own services meant that choice was being linked to greater inefficiency and costs.
Angela Coulter, chief executive of the European branch of the Picker Institute, an organisation that aims to improve the quality of health care, said choice was popular with patients and that the recent piloting of choice in London and for coronary heart disease had "resulted in better, coordinated care."(Ann McGauran)