Patients to benefit from largest expansion of choice in a decade

Patients could benefit from a wider range of healthcare services as the government announces its intention to roll out the biggest expansion of choice in the NHS in a decade.

Under the proposals, patients requiring routine treatment outside of hospitals will be able to choose between multiple services across the NHS and independent sector. This expansion of choice will give patients access to faster, more convenient treatment.

Services that could be offered under the expansion include endoscopy, nutrition and podiatry. NHS England will be engaging with integrated care boards (ICBs) with a view to launching pilots in local areas from the autumn. ICBs in areas across the country are expected to participate in some form. NHS England will also actively encourage ICBs to consider expanding the range of providers of services already covered by existing choice regulations, such as mental health. Subject to the results of local pilots, the government and NHS intend to expand choice to many more areas of the country and many more services.

The government says that improved patient choice can lead to shorter waiting times for patients, where another option is available and is clinically appropriate. It may also have an impact on the overall longer waiter position by either incentivising providers to offer appointments or enabling prioritisation of long waiters across the system.

Prime Minister Rishi Sunak, said: "Today’s announcement represents the largest expansion of choice in the NHS in a decade. From hearing aid care to mental health treatment and diagnostic tests such as endoscopy, our new approach will help speed up treatment, improve the quality of care and ensure that patients have more choice over where they receive treatment.

"Expanding choice will not only help get patients the care they need more quickly but is part of our plan to cut waiting lists, building on the progress we have already made with a fall of almost 200,000 since September."

Health and Social Care Secretary Victoria Atkins, said: "Empowering patients to take control of their own healthcare decisions is a key part of my missions to make the NHS faster, simpler and fairer for everyone that uses it. Expanding patient choice will enable people to choose when, where and how they are treated - putting power in the hands of the patients."

NHS national elective recovery director, Sir James Mackey, said: "Giving patients greater choice over where and how they receive their care is a vital part of NHS plans to recover and reform after the pandemic, with patients across the country already able to choose where they receive planned care including surgery, with information including waiting times at all providers to help patients make the best possible choice for them.

"The announcement of a pilot to expand this type of model to some out-of-hospital services will give patients more control over the different types of care they need, with the aim of helping to improve waiting times and quality of care."

Chief Executive of National Voices, Jacob Lant, said: "Giving patients and their families more choice is always positive, as it helps people to make healthcare decisions that fit around their lives and responsibilities. It is vital that services help patients understand these choices and promote the support they can offer with common barriers, such as transport costs. It is this wraparound support that ensures choice is meaningful and everyone can access and benefit."

David Hare, Chief Executive of the Independent Healthcare Providers Network (IHPN), commented: "This announcement is hugely welcome and will have real benefits for patients through widening the range of high-quality services available to the public and reducing overall waiting times for a broader range of NHS services.

"Our recent ‘Time to Choose’ report with the Patients Association found that patients want to be given a choice and, when offered it, can cut on average over 3 months off their wait for NHS care by exercising their right to choose a different provider - whether NHS or independent sector - something that could make a real difference in tackling care backlogs.

"We also welcome the publication of the Independent Panel on Patient Choice and Procurement’s report which rightly emphasises the importance of tackling local barriers to patient choice, including ensuring there is real-time local data to identify any available capacity in the health system - enabling people to make the most informed decisions around their care and ultimately cutting the time they wait for treatment."

Services which could be within scope for the pilots include:

  • hearing aid care
  • some diagnostic tests, such as endoscopy
  • dietetics and nutrition
  • ambulatory ECG (heart activity)
  • podiatry

NHS England will begin detailed engagement with a subset of ICBs to discuss the potential for piloting introducing choice for certain pathways of care in a local area. Over the coming months, NHS England will begin work with the subset of ICBs to work through the practical actions to establish choice in new pathways including identifying the barriers as well as quantifying the activity, financial and capacity impacts. 

Patients can already choose where they receive care when referred to an in-hospital consultant-led service. Following a consultation with their GP, patients should be offered information on a minimum of 5 providers, with information about waiting times, distance to travel and quality to help them make their choice. This allows patients to choose the healthcare that is right for them - whether that is selecting a hospital with a shorter waiting time, or choosing a location where they can recover close to friends and family.

At present, any organisation which wants to provide planned hospital care - for procedures like hip replacements - is able to offer these services to NHS patients, free of charge, provided they meet NHS standards and costs. Patients can then choose to be treated there, helping ease pressure on other NHS services and cutting waiting times.

In the expansion of choice, ICBs will include a range of providers across the NHS, charity and independent sectors to offer services to patients, which will be free at the point of use and at NHS costs and standards.

The government and NHS also announced that they will implement the recommendations of the chair of the Independent Patient Choice and Procurement Panel that help to remove the barriers to patients exercising choice, including by publishing more data on choice and appointment bookings to help ensure that patients are more readily able to choose their hospital care and support the further expansion of choice. The response to Andrew Taylor’s report will set out the next steps NHS England will take to remove barriers to patients exercising choice.

Andrew Taylor, Chair of the Independent Patient Choice and Procurement Panel, said: "Removing local barriers to patient choice will help patients choose the hospital that best meets their needs, while also helping the NHS offer services where they are needed most. I am pleased that my recommendations, which will help alleviate constraints on patient choice, have been accepted by the government and the NHS."

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