Observations Body politic

Collision, collusion, and confusion

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39255.707488.94 (Published 28 June 2007) Cite this as: BMJ 2007;334:1349
  1. Nigel Hawkes, health editor
  1. The Times
  1. nigel.hawkes{at}thetimes.co.uk

    Choice for patients, localisation of services, and practice based commissioning—can these and other NHS agendas all be followed successfully at the same time?

    Choice is the mantra of the new NHS in England. Since the beginning of 2006 all patients across the country have theoretically been able to choose where and when they get hospital treatment—a great leap forward in empowerment of patients, if we are to believe ministerial statements on the subject. Hernias in Halifax, gall bladders in Gloucester: the world's your lobster, my son, as Arthur Daley used to remark in Minder.

    But it is never long in the NHS before one policy begins to collide with another. No sooner was choice up and running than ministers discovered the joys of localisation. Services offered locally, conveniently, and more cheaply formed the basis of Our Health, Our Care, Our Say, the white paper that also emerged in 2006.

    GPs and independent companies are now being encouraged to provide such services in competition with hospital trusts. Primary care trusts are uneasy about this—and with good reason. Rightly or wrongly they still feel a responsibility for the preservation of secondary care; and an uncontrolled “free for all” could seriously disrupt the local …

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