Liberating the NHS: Greater choice and control

The Coalition Government has come to power with an aim to restructure the provision of healthcare in England. It has published an introductory white paper and several subsequent consultation papers. This document offers a précis of the consultation on ‘Greater choice and control.

The Government's White Paper, ‘Equity and Excellence: liberating the NHS’ sets out proposals which assume greater choice and control over care and treatment, including choice of healthcare provider. This consultation explains the proposals for greater choice and control over care and treatment and leading to an NHS is that is more responsive to patients needs and wishes. It seeks views on:

• Proposals for offering more choice for patients and service users
• How shared decision making can become the norm
• How it can happen: information, 'any willing provider' and other tools
• Making safe and sustainable choices

Some of the proposed methods to assist people in making choices include:

• The arrangement needed to support choice of any willing provider, such as pricing;
• The technology, like Choose and Book, that people can use to make their choice;
• Possible new duties on healthcare providers and professionals; and,
• Personal health budgets.

‘Liberating the NHS’ set out a number of specific choice commitments around extending choice of provider and treatment in planned hospital care and, more specifically, in maternity, mental health, end of life care and management of long term conditions.

Shared decision making is one of the foundations to enable real choice and this consultation examines how this can be built into health professionals’ everyday practice, building on the theme of ‘no decision about me without me’. 
This consultation also links heavily with that on ‘An Information revolution’ in ‘ensuring that people have the information they need to make informed choices, presented in a way that they can understand is vital when making choices’.
It recognises that there will be major challenges in making sure that everyone can exercise choices that do not cause problems for either them or the NHS. 

Points of issue

  • The ‘any willing provider’ model is advocated in this consultation, providing greater choice for patients. All willing providers need to have the same access to data and the same level of support to provide services. While we support the principle of the ‘any willing provider’ model there must be a level playing field for all providers, including new entrants to the market, with equal opportunities for all and an understanding of the different cost models in place for all providers.  Also, information on service provision and outcomes needs to be comparable.
  • It is unclear how choice will be implemented in rural areas where there is limited access to services. In this case choice of provider will be dependent on where you live.
  • Information provision on its own is not enough to make informed choices. Information needs to be interpreted so that patients can fully understand the implications.
  • It is unclear exactly how personalised health budgets will work, although we are aware that the system is currently being piloted
  • Patient choice of GP practice could have consequences on the community pharmacy network. The electronic prescription service would need to allow for choice of medicines supply to be exercised


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