Men’s health centre

Patients 'losing out' in NHS choice

29th July 2011 - Some NHS managers have adopted anti-competitive practices that result in patients losing out on their right to choose the hospital in which they want to be treated, according to an investigation.

A study by the Co-operation and Competition Panel (CCP) found that some health service bosses in England were trying to save money by delaying operations in the hope that patients would remove themselves from the waiting list.

'Serious risk' to choice

The CCP found that this was one of a number of tactics being used by some managers to restrict patients' rights. It warns that unless the failures are addressed, reforms opening up other aspects of healthcare to competition - known as the Any Willing Provider policy - will be "at serious risk".

The Panel was asked in December 2010 to investigate how the system of choice was working. Under existing rules, patients can choose a hospital for elective surgery, including private hospitals as long as they conform to certain rules.

The report says that, while some health commissioners are successfully balancing the constraints of tight budgets and patient choice, others are restricting choice without good reason. Tactics include block contracts, where some hospitals are guaranteed a quota of patients, and limits to the number of patients that some providers can treat.

Longer waiting times

Other managers have made patients wait longer for surgery, with one Primary Care Trust telling investigators that it was increasing waiting times from 13 to 16 weeks to save cash. The CCP said some executives believed that patients would "remove themselves from the waiting list either by dying or by paying for their own treatment at private sector providers".

"Commissioners have a difficult job in the current financial climate, but patients’ rights are often being restricted without a valid and visible reason," Lord Carter of Coles, Chair of the CCP said in a statement. "Crucially, it is the lack of transparency that surrounds certain restrictions on patient choice that is of real concern."

Despite these problems, there is evidence that patients and taxpayers are benefitting from higher quality care, greater accessibility, and more efficient delivery in services that represent around 15% of PCT expenditure on healthcare (i.e. approximately £12 billion in 2009-10). These benefits can be expected to grow as patients become more aware of their ability to choose, and providers respond to patient expectations by improving services, the inquiry team said.

Transparency

In a series of recommendations to the Department of Health, the CCP calls for health commissioners to be compelled to publish each year a list of any restrictions they have imposed on patient choice, and set out their reasons for doing so. They also want Primary Care Trusts to display clear information on their websites about minimum waiting times imposed on healthcare providers.

Commenting on the report, Health Secretary Andrew Lansley said in an emailed statement: "This is exactly why we need to put patients' interests first. Too many PCTs have been operating in a cynical environment where they can game the system - and in which political targets, particularly the maximum 18 week waiting time target, are used to actually delay treatment.

"When GPs, specialist doctors and nurses are making the decisions, as they will under our plans, they will plan care on the basis of the clinical needs of patients and their right to access the best service, including the least possible waiting time."