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Last Updated: Wednesday, 31 May 2006, 06:21 GMT 07:21 UK
Patient surgery choice extended
Surgeons
Each year 9.4m referrals for non-emergency treatment are made
Patients are to be given a choice of hospitals across England for operations as a key NHS reform is expanded.

Ministers are to announce that 32 foundation trusts will be added to the list of local hospitals that patients currently choose from.

From the start of this year, people have been able to choose between four hospitals for elective surgery.

But patient groups said people tended to want to stay local so the extra choice would not mean a great deal.

Patient choice has been one of the government's key reforms to make the NHS more patient-friendly.

Patients have told us that they appreciate having choice of local hospitals
Michael Summers
Patients Association

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

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.

A task force has also been set up under Mayur Lakhani, chairman of the Royal College of GPs, to investigate how to extend patient choice into other areas of healthcare.

But despite the government's enthusiasm for the reforms, opinion polls have consistently rated it as a low priority for patients.

Patients 'not interested'

The Department of Health's own research published at the launch of patient choice in January found that eight out of 10 people knew little about it.

And only 14% would be prepared to travel outside their area for treatment.

The roll-out has also been hampered by delays to the 6.2bn IT upgrade. As part of the project, a system called choose and book was meant to set up to allow appointments to be made online.

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
Andy Burnham, heath minister

But only a quarter of GP surgeries had the system in place at the beginning of the year and a fifth still do not have it, the latest figures suggest.

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."

And Alyson Pollock, professor of public health policy at the University of Edinburgh, questioned whether the public really wanted choice as opposed to good local services.

"The people who will be able to exercise their choice will be the people with the information at their disposal, something that clearly will put the middle classes at a benefit."

But Health Minister Andy Burnham said 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."

But 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.

A report on patient choice is due to be published by the King's Fund health think-tank on Wednesday.


How important is it to be able to choose where to receive NHS treatment? Would you prefer to travel outside your area for treatment? Send us your comments about patient choice using the form below.

Your views

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



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