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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Patient choice and the NHS – the debate goes public

Filed Under (BBC, Health Policy, Primary Care Trusts) by Paul on 29-03-2011

The BBC has just launched its own analysis on Radio 4’s Today programme examining NHS progress toward the development of competition. Nick Triggle’s report also appeared on the BBC’s website.

They believe that there is evidence that PCTs are restricting the level of competition and argue that this is happening because some health managers are actively rebelling against plans to create greater competition in the NHS.

“The BBC has learnt that many English trusts are introducing steps that make it harder for patients to opt to have NHS care done by private hospitals.

Health firms said it was a sign of bias, while ministers said there was no justification for the restrictions.

The behaviour of nearly half of local NHS management bodies is now being looked at by a government inquiry.

NHS patients needing non-emergency operations, such as hip and knee replacements, are already able to be treated by private hospitals that have agreements in place to carry out the care at NHS cost.

At the moment, only 3.5% of operations are done this way, but under the government’s shake-up of the health service the number is set to increase.”

They claim that in recent months managers working for PCTs have started trying to impose restrictions that channel patients away from private hospitals.

Those on the inside will recognise that this ‘finding’ is not new but comes in fact from the interim report of the Co-operation and Competition Panel on behalf of the Department of Health. Its interim findings suggested that as many as 70 of the 151 PCTs are employing such tactics.

However the relationship between what they have uncovered – that there are actions by PCT managers to limit private competition – and the motivation they claim for these actions – that PCT managers are doing this to frustrate Government policy – is unlikely. Many PCTs were doing this for some time before the last General Election

The tactics the BBC outlined are familiar to all of us who have been trying to increase patient choice for the last 8 years.

  • Block contracts – PCTs promise NHS hospitals a certain number of patients, leaving the private sector only what is left over
  • Minimum waiting times – Insisting patients wait a certain length of time before treatment. Health firms say this is about lowering the bar so that they cannot use the pulling power of quicker care
  • Activity caps – Limits on the number of patients that can be referred on to private hospitals
  • Fewer options – Reducing the range of treatments the private sector can offer to NHS patients

However some commentators feel that patient choice has been undergoing greater restrictions in the last few months.

David Worskett, director of the NHS Partners’ Network, which represents those private firms which see NHS patients, said the tendency within the NHS at the moment was one of “retreat” away from choice and competition.

It is absolutely the case that in this period of transition that independent sectors are facing significant difficulties. The practices seem to be bias against the independent sector.”

But David Stout, of the PCT Network, was on the radio explaining that what PCTs were doing was not necessarily against the rules. He went on to explain that one of the reasons that a PCT might want to restrict patient choice was so as not to destabilise the local NHS hospital.

And it is with that motivation that Government policy collides with itself. The Government reforms are intended to provide patients with greater choice, but when patients chose to go to another provider the NHS hospital will lose business and income.

Should PCTs have keeping local hospitals stable as one of their aims? Should that be one of the aims of the GP Commissioning Consortia?

If that is the case, as David Stout pointed out, PCT managers (and GP commissioners) will be able to say they are following the rules (keeping local NHS hospitals stable) and to achieve that aim they will restrict patient choice.

Will the Government say that patient choice is more important than stable local NHS hospitals?

If not David Stout is right, and will be into the future, commissioners are doing nothing wrong.


2 Responses to “Patient choice and the NHS – the debate goes public”

  1. Paul
    A very interesting debate and one that is very real in an economy where I am currently. I am trying to commission a 4 week RTT pathway and providers appear unable to respond, particularly at volume(so the ‘quicker’ argument becomes irrelevant). Hopefully the enquiry will also look into the behaviour by the SHA and other ‘performance managers’ and regulators and the messages they are sending about ‘working with providers’ to deliver QIPP.

    The model going forward should (theoretically) be as intended with PbR – the money follows the patient. Commissioners will have to control demand through clinicians to a level that is unprecedented in the UK and analogous with a sophisticated health care insurer. Is the system up to this challenge?


  2. This is certainly a long standing issue and one of the key reasons why PCTs have often not been effective commissioners. Many of the arguments between the Commercial Directorate at DH and PCTs during the rollout of ISTCs were about PCTs behaving as advocates for the local hospital and not the patient.

    Even now many PCTs see maintaining the status quo at their local hospital as an important goal when they should be using competition to encourage quality and speed improvements for patients. Of course, this is also one of the reasons why many doctors oppose any provider competition as it will, if implemented correctly, dramatically increase the pressure to improve their working practices.

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