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Choice drive is passing patients by

The number of patients exercising their right to choose their hospital may have more than doubled, but it's still a tiny proportion – and the choice drive is proving to have other negative consequences...

The number of patients exercising their right to choose their hospital may have more than doubled, but it's still a tiny proportion – and the choice drive is proving to have other negative consequences...



Back in the early years of this Labour Government, then Prime Minister Tony Blair appeared to be flailing around for a big idea that could come to define his period in office. He settled, after much agonising, on reform of public services, and his epiphany was this – that public services would only be able to maintain support, and justify increases in funding, if they became more responsive to the needs of their users. The 1997 Labour manifesto had pledged to scrap the internal market in the health service the Tories had created, but by the 2000 NHS plan the market was back in vogue – and along with its plans for a new era of patient choice.

Now, Mr Blair was notoriously more enthusiastic for the sweeping rhetoric of policy than for fine detail. While he quickly insisted GPs should be offering their patients a choice of hospital, he did little to test the effects of the policy or even to ensure that it was actually being enacted. Still, where the Government failed, Pulse has stepped into the breach, with this week's investigation into the impact of the choice agenda.

The findings are fascinating, although more for the intricate picture they paint of the effect of choice on the ground than for their surprise factor. GPs have been saying for years that choice was an irrelevance in many areas of the country, and that is exactly what our investigation has found. In rural areas, just 3.5% of patients referred over the past financial year came from outside a hospital's immediate catchment area. The overall figure is higher but still pretty tiny, at 6.4%. The Government will point to the 114% increase in the proportion of out-of-area referrals since 2004/5, but this is in comparison with a time when choosing to attend a hospital outside your area was almost unheard of. A doubling of almost nothing is still not a lot.

There is the odd titbit of more genuine encouragement for the Government. The big concern about patient choice had been that it would be middle-class patients who would disproportionately take advantage of it. That may still be true, but our analysis suggests the effect might be outweighed by another – the fact hospitals in deprived areas also tend to be in cities, where choice is much easier to exercise. If you don't correct for geography, there is actually more choice going on in deprived areas than in affluent ones.

But for GPs, perhaps the most worrying implication of the drive for choice of hospital is maybe one of the least obvious. The creation of an open market among hospitals has not only set secondary care facilities against each other but also set secondary care against primary care, by providing a direct financial incentive for hospitals to actively campaign for custom. Hospitals, even the bad ones, are not the losers here. General practice, which was supposed be gaining funding from hospitals to pay for new community services, just might be.

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