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Last Updated: Wednesday, 31 May 2006, 12:24 GMT 13:24 UK
NHS choice 'worsens inequalities'
Each year 9.4m referrals for non-emergency treatment are made
Patient choice over where to go for surgery could lead to a widening of health inequalities, experts say.

The King's Fund health think-tank found in a poll of 1,000 people that those with formal education were likely to choose the best hospitals.

But the government-commissioned study said those without such qualifications often opted for the local hospital.

The findings come as the government announced a major extension of choice to cover foundation hospitals.

Since January, patients have had a choice of at least four hospitals for treatment, one of which can be a private centre, for non-emergency treatment.

There is a parallel with school with middle classes tending to gravitate towards what they perceive as the better schools
John Appleby, of the King's Fund

Many primary care trusts included more than the minimum of four on their lists, to which they will now add the 32 foundation trusts - top performing hospitals which have been given more autonomy than other hospitals.

Choice will be extended later in the year to include 15 private clinics providing NHS care from treating hip replacements to cataract operations. And by 2008 patients will be able to choose to go to any hospital in the country.

But despite the government's enthusiasm for the reforms, the King's Fund research - carried out on a hypothetical basis - calls into question one of its key NHS policies.

Professor John Appleby, chief economist at the King's Fund, said: "There is a parallel with schools with middle classes tending to gravitate towards what they perceive as the better schools.

"If this happens in health care we could see potentially a widening of health and health inequalities between those with formal education qualifications and those without."


And Niall Dickson, chief executive of the think-tank, added if patient choice was to succeed it was essential people were given support to help them make choices.

The Patients Association has also questioned how much choice the public actually wants.

Michael Summers, chairman of the Patients Association, said: "Patients have told us that they appreciate having choice of local hospitals.

"However, it also seems they are not all that interested in being able to go to hospitals anywhere in the country.

"There are exceptions, but on the whole extending the choice does not mean a great deal to many."

The Tories accused the government of making a reannouncement and urged ministers to extend choice to all hospitals.

And Liberal Democrat health spokesman Steve Webb said the move would further destabilise and already "fragile" health service.

But Health Minister Andy Burnham defended the policy, saying he believed expanding the system would lead to improved patient care.

"We are at last putting patients in control and creating a health service where care is provided to their convenience and not the health provider."

Below is a selection of your comments:

Choice only has any meaning for people in and around London, with its concentration of hospitals and specialist services. The rest of us want our local hospital to be clean, efficient and reliable. Yes we do want the NHS to be more flexible when booking hospital appointments, but I don't believe many people want to shop around for their treatment in the way they do for an electricity supplier.
Mat Jordan, Sheffield, UK

I would definitely be happy to travel outside of my local area for treatment. The more choices that are opened up to people, the more the underperforming hospitals will have to challenge their internal issues of bad management/reputation/unhygenic environments!
Sally Harris, Newcastle upon Tyne

Why can't local hospitals be brought up to standard so that people don't have to travel? I've been in hospitals in the poorest part of southern Italy that have better quality care and cleanliness than the big hospital in Leicester where my grandfather stayed for a long time. It's just silly that hospitals in England are not all of a high standard.
Helen Forbes, Cambridge

All this talk of 'choice' is nothing more than an interesting insight into hermeneutics. Let me give you a local example that makes nonsense of the use of the word. The local health trusts in Huddersfield recently, despite opposition from many local people, decided that consultant-supported maternity care would only be available in Halifax, and have stopped the service in Huddersfield. I'm sure many others can provide you with similar examples from around the country. With services being 'rationalised' choice will mean nothing more than selecting the least worst option.
Bill Smith, Leeds

Choice is important because without it, the sort of service required by everyone, is unlikely ever to be delivered. Choice is a means to an end. I don't want a choice in cars either - I just want the right type of car to be available to me. This is only ever going to happen as a result of competition - i.e. choice
Simon Humphries, London, England

It seems to me that choose and book has two possible outcomes: 1) the money diverted away from genuine health care means that there will be a choice of 4 mediocre hospitals, rather than just going to your local one made good by better funding 2) given that acute care trusts are funded from the PCTs on services delivered, those hospitals which get selected more often will be better funded, better equipped, and thus more selected in future. This would lead to a two-tier healthcare system - perhaps even leading to the closure of small local hospitals. Hardly patient choice!
Alasdair Moffat, Stoke-on-Trent, uk

Choice has always been something that has been considered by the wise and the good to be something that ordinary people are incapable of exercising in a rational and reasonable way. The reaction of some health professionals and politicians is usually informed only by their own opinions and of their equally blinkered peers.

There are many ways in which people will choose to exercise this extension of the number and location of hospitals from which they they can select. I suggest just one example which is driven not by performance league tables, but by sheer convenience. It may be that an elderly person might choose to be treated close to their family which happens to be resident in another part of the country. The benefits that might result are obvious and wide ranging.
Terry Jackson-Baker, Stockport uk

Watch an interview with Health Minister Andy Burnham

Patient surgery choice extended
31 May 06 |  Health
Doctors assess patients' choice
01 Jan 06 |  Health
Is real NHS choice possible?
14 Nov 04 |  Health

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