Doctors sceptical that new policy will greatly increase choice

BMJ 2001; 323 doi: (Published 15 December 2001) Cite this as: BMJ 2001;323:1385
  1. Annabel Ferriman
  1. BMJ

    The health secretary, Alan Milburn, last week announced that he was going to introduce more patient choice into the health service by offering patients who had been waiting more than six months for heart surgery the chance to be treated in a hospital in the private sector or abroad.

    Unveiling the policy, which is to start in July 2002, he said: “We are publishing proposals that will for the first time give patients an explicit choice over where they are treated in the NHS.” All patients who had waited more than six months—not just patients needing heart surgery—would be included in the scheme by 2005.

    Several organisations representing doctors and health authorities expressed scepticism about the new policy.

    Dr Ian Bogle, chairman of the BMA, pointed out that, although the scheme to send patients abroad was being “sold under the banner of choice,” the amount of choice that it was actually going to give patients was very limited.

    Decisions on whether to offer a patient the chance of being treated abroad were going to be made by hospital trusts, not by GPs, in collaboration with the patient. “The GP referral will have been made and the patient will be on a waiting list [of a hospital trust]. Then the decision will be made at trust level,” Dr Bogle said.

    He said that he thought it would have been more logical for those bodies commissioning health care, the primary care trusts, to decide which patients should be offered treatment abroad. But the government had realised that there was a snag to that arrangement. “It would have meant a lot of extra money being put into the system immediately,” he said.

    Instead, hospitals will ask patients who have been waiting for more than six months if they would like to be treated abroad. Dr Bogle said that it had not yet been made clear exactly how the scheme would work regarding the private sector, but he thought that the arrangements would be similar.

    Dr Bogle said that the BMA broadly welcomed the idea, with two caveats. The scheme had to be funded properly; otherwise “we are going to denude hospitals of funds.” And it should be regarded as an interim measure, because ultimately the NHS had to become self sufficient.

    Dr Peter Hawker, chairman of the BMA's consultants committee, said: “In an ideal world patients would have the choice to be treated quickly and close to home. While supporting the government in their current initiative, we urge them to invest in the NHS, to build up capacity.”

    Nigel Edwards, acting chief executive of the NHS Confederation, which represents NHS management, warned that the expansion in the use of private hospitals by the NHS could provide incentives for staff to leave the NHS. “The problem, however, remains our shortage of key staff,” he said.

    He also thought that if the NHS used the private sector more, costs might rise. “The laws of supply and demand mean that there is a danger that the increase in spending could raise private sector costs as well as increasing capacity.”

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    Dr Ian Bogle: the policy is “being sold under the banner of choice”

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