Choice in health - The Economist (blog)

When it comes to health policy, 'choice' has been the mantra of...well...choice for successive governments for about as long as I can remember. The current government's reforms, we're told, are not only going to transfer power from the tyrannical rule of managers and put it in the hands of GPs, but will also bring 'real patient choice' to the NHS for the first time.

But a quick search of the Department of Health website reveals a plan for reform which promises to 'strengthen patient choice' from a full eleven years ago, and I'm sure a brief look through their paper archives would reveal documents saying similar things for many years prior to that too. I understand the motivation for this, though; everyone likes to feel like they have a decent level of control over their lives, and it's hard to deny that when it comes to availing themselves of public services, people can often be made to feel like they're very much in the passenger seat. Giving people options – about which GP practice to join or whether they really want to go in for surgery to deal with that trapped nerve, for example – gives them a much greater feeling of autonomy, and that can hardly be a bad thing, right?

Well, sort of. The thing is, not much I've seen of working in the NHS has made me think choice is all it's cracked up to be. Not that it's a bad thing, you understand, (though apparently evidence suggests that it can be sometimes); it just seems a bit odd to prize it so highly relative to everything else.

For one thing, there's the problem of actually getting access to the information that would enable you to make a meaningful comparison between the different places you could go for treatment. This information is freely available from an admirably accessible and easy-to-use website called NHS Choices, which would be a perfect solution if not for the fact that the people most likely to need medical care tend to be elderly, and 60% of over-65s have never accessed the internet in their lives. And even if every pensioner was a keen silver surfer, a lot of people genuinely aren't interested in having a choice of hospital anyway. A large proportion of the people who come to the department where I work have been using the hospital for decades and wouldn't dream of going anywhere else – not because the care we provide is particularly amazing, but just because we're their local hospital and they've always come here. And this is in a big city; imagine how much more true that's likely to be for a small district hospital in rural North Yorkshire where the nearest alternative is an hour's drive away on winding country roads.

Or take waiting lists. These are probably one of the biggest obstacles to improving patient care where I work. They were notoriously bad throughout the country back in the 1990s, then got considerably better over the past few years, and are now getting worse again as targets are abolished and the funding shortfalls start to kick in (meaning that managers – including my own – are very reluctant to hire locums or pay overtime for extra clinics). I've seen waiting times in one of the departments where I work go up by roughly a third – from six weeks to eight – in about as many months. Two extra weeks might not sound that long to wait, but if you're in constant pain (as a lot of patients will be whose cases aren't urgent) it's pretty likely you'll be acutely aware of every extra day.

And giving patients a choice about which hospital to go to doesn't help with this. If the reason for the long waiting list was that the department where I work was being run less efficiently than the one run by our counterparts in the hospital up the road – and if patients had access to detailed, up-to-date information about waiting times – then maybe letting patients choose which hospital to go to would do some good. But our waiting times have gone up because budgets are tighter and because the trust doesn't get fined for patients who have to wait too long for treatment any more. Both of those are going to apply to every hospital in the country. Letting patients choose to go to the equally-struggling department in the hospital up the road (or letting GPs choose, as is also going to happen with the new reforms) isn't going to improve things much.

The NHS is a long way from perfect; anyone can see that. I see it on a daily basis. I'm not just not sure how 'choice' is meant to help.