Choice in the NHS is limited to waiting times, BMA chief says
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《英国医生杂志》
The government is using "patient choice" as a means to drive down costs and introduce competition between the NHS and other care providers, the BMA told MPs this week.
James Johnson, chairman of the BMA Council, told the House of Commons Public Administration Select Committee that the government's claims to be giving patients more choice was in practice limited to a small area of policy: the reduction of waiting times for inpatients.
From December 2005 patients will be given a choice of hospitals for elective treatment, which may include non-NHS facilities. Under the new funding system for acute hospital trusts, known as "payment by results," the NHS loses money if patients opt to go to a private facility.
Mr Johnson told the committee: "At present, choice is too much centred on waiting times. Patients may be able to choose from five different hospitals to go to if they need an operation, but does that really matter to them?" He asked what choice there was for users of mental health services, elderly people, and users of children's services.
"Patient choice is clearly being employed as an economic concept, and doctors worry the concept is being mis-sold in the NHS. Current policy seems more aimed at providers rather than patients and a belief that competition will drive standards up and waiting lists down as services try to attract patients," he said.
Mr Johnson agreed that patients wanted choice but said this didn't mean treating them like "supermarket customers" and offering them cheaper and quicker options of care.
"Recent research and polling consistently show that patients want more personal guidance, better continuity of care, and more time with professionals," he said.
He said payment by results "hasn't been properly thought through" and that ministers had admitted to him that more work was needed.
"You have an NHS outfit and a private outfit competing for surgical patients. If the patient chooses the private outfit because it has a better lunch, or whatever, the money goes there. But the NHS hospital will also be providing a whole load of other services that no private hospital would want to do, such as A and E . But if you destabilise the NHS hospital because the money has gone to the private sector, how do you provide these core services?" Mr Johnson said.
Professor Allyson Pollock, of the Public Health Policy Unit, University College London, also gave evidence and echoed his view.
"The government has stated its intention to move 15% of elective work out of the NHS and into the independent sector."(Rebecca Coombes)
James Johnson, chairman of the BMA Council, told the House of Commons Public Administration Select Committee that the government's claims to be giving patients more choice was in practice limited to a small area of policy: the reduction of waiting times for inpatients.
From December 2005 patients will be given a choice of hospitals for elective treatment, which may include non-NHS facilities. Under the new funding system for acute hospital trusts, known as "payment by results," the NHS loses money if patients opt to go to a private facility.
Mr Johnson told the committee: "At present, choice is too much centred on waiting times. Patients may be able to choose from five different hospitals to go to if they need an operation, but does that really matter to them?" He asked what choice there was for users of mental health services, elderly people, and users of children's services.
"Patient choice is clearly being employed as an economic concept, and doctors worry the concept is being mis-sold in the NHS. Current policy seems more aimed at providers rather than patients and a belief that competition will drive standards up and waiting lists down as services try to attract patients," he said.
Mr Johnson agreed that patients wanted choice but said this didn't mean treating them like "supermarket customers" and offering them cheaper and quicker options of care.
"Recent research and polling consistently show that patients want more personal guidance, better continuity of care, and more time with professionals," he said.
He said payment by results "hasn't been properly thought through" and that ministers had admitted to him that more work was needed.
"You have an NHS outfit and a private outfit competing for surgical patients. If the patient chooses the private outfit because it has a better lunch, or whatever, the money goes there. But the NHS hospital will also be providing a whole load of other services that no private hospital would want to do, such as A and E . But if you destabilise the NHS hospital because the money has gone to the private sector, how do you provide these core services?" Mr Johnson said.
Professor Allyson Pollock, of the Public Health Policy Unit, University College London, also gave evidence and echoed his view.
"The government has stated its intention to move 15% of elective work out of the NHS and into the independent sector."(Rebecca Coombes)