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Patient choice to lead to inequalities in care

By Rob Finch

The Government's patient choice drive will lead to inequalities in care provision and may raise costs in the health services, a major NHS-funded review has concluded.

The scoping review by Manchester and Cardiff universities found increasing patients' choice of hospital will have 'unpredictable results' and may not increase quality.

It adds that the Government has forged ahead with expanding choice, despite little empirical evidence. Choice was not even a high priority for patients, the researchers found.

The only apparent backing for the flagship policy was a single pilot study carried out on patients facing long waiting times in London, the review said.

The review, Patient Choice and the Organisation and Delivery of Health Services, concluded: 'Results of pilots cannot be used as a reliable guide to predict the demand, uptake and effects or even satisfaction rates of the users, when they are rolled out on a national scale.'

Author Dr Marianna Fotaki, lecturer in health care management at Manchester Business School, said the policy was based on 'assumptions' rather than hard evidence.

She added: 'In a nutshell, it's mostly articulate people with a "voice" that can exercise choice better.

'If everyone benefits from choice it may still exacerbate

inequalities. Some people may be more able to use it than


The report highlighted the introduction of choice in education which it said 'provided ample evidence of cream-skimming and negative conse- quences for equity'.

GPs said the Government had made a mess of introducing the policy and had 'insulted' their integrity by implying they did not offer any choice beforehand.

Dr David Bevan, a GP in Upwell, Cambridgeshire, who resigned as a local choice lead last year, said: 'Choice had an opportunity to deliver in health but they missed it by making Choose and Book and Payment by Results more important than what people want to choose.'

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