“Patients will have more choice: No decision about me without me.”

The ‘reforms’ have been acclaimed by the government as increasing patient choice. But this is not as good as it sounds:

  • The proposals for the NHS tend to make no distinction between ‘choice’ and ‘shared decision-making’. Good GPs will anyway work in partnership with their patients and ensure shared decision-making about the nature or extent of patients’ care or treatment. The ‘reforms’ do little to ensure this where it is not already happening.
  • Information about the ‘reforms’ says that patients should be able to choose between service providers – at least in certain instances, like pre-diagnostic tests (e.g. non-obstetric ultrasound). But it is hard to know how patients can make a meaningful choice between such providers except on the basis of who is easiest to get to, or who can see them most quickly. The vast majority of patients do not have the kind of information that allows them to make a meaningful choice between providers on the basis of who will offer the safest or best quality service, and it will be unlikely that they will be able to get any advice on this. A dispute about the safety of cardiac surgery for children at Leeds Infirmary has shown how difficult it is (and how many factors are involved) in assessing the service offered by a provider (http://www.independent.co.uk/news/uk/home-news/future-of-child-heart-surgery-at-leeds-general-infirmary-still-in-the-balance-despite-resumption-reports-8561050.html ).
  • ‘Patient choice’ looks unrealistic if GP practices are being offered money in return for sending fewer patients to hospital to receive potentially expensive treatments. http://www.guardian.co.uk/society/2012/aug/31/nhs-rationing-risking-lives-doctors-leader. Some GPs are given targets to lower the number of patients they refer to hospital. Others may have their referrals scrutinised by staff at a referral management centre who may have no knowledge of the patient or no clinical training. Some operations such as hip replacements are now rationed or no longer available. There is now less choice for patients, not more.
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