Intended for healthcare professionals


Mapping choice in the NHS: cross sectional study of routinely collected data

BMJ 2005; 330 doi: (Published 03 February 2005) Cite this as: BMJ 2005;330:284
  1. Mike Damiani, visiting senior analyst1,
  2. Carol Propper (carol.propper{at}, professor2,
  3. Jennifer Dixon, director1
  1. 1 Policy Directorate, King's Fund, London W1G 0AN,
  2. 2 Department of Economics, University of Bristol, Bristol BS8 ITH
  1. Correspondence to: C Propper
  • Accepted 15 November 2004


Objective To identify where in England there are likely to be most constraints on choice of hospital for patients waiting longer than six months for elective care.

Design Cross sectional study using routinely collected data.

Setting Population of England and NHS trusts and private sector hospitals in England.

Participants All residents in England.

Main outcome measures Availability of beds (available and unoccupied hospital beds), demand (number of people waiting longer than six months), and access (travel time to facilities) to hospital care in England.

Results Most people in England already have an extensive potential choice of hospital. The number of available and unoccupied beds within 60 minutes' travel time was lowest in the Scottish borders, North Yorkshire, and parts of East Anglia, Lincolnshire, Devon, and Cornwall. This pattern was not altered by adding in private facilities. Putting demand with this supply, the number of people in a geographical area waiting longer than six months per bed within 60 minutes' travel time was highest in the south east (except London), parts of the south west (Cornwall, Bristol), East Anglia, and the Welsh border.

Conclusion People in the south east (outside London), East Anglia, and parts of the south west are likely to have to travel further to exercise meaningful choice of hospital for elective care.


  • Contributors JD and CP conceived the study. All, in particular MD, developed the methods. MD was responsible for the analysis and producing the maps. JD and CP wrote the article. MD commented critically on the paper. CP revised the paper in the light of reviewers' comments. All authors are guarantors.

  • Funding None.

  • Competing interests None declared.

  • Ethical approval Not required.

  • Accepted 15 November 2004
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