The government’s relentless drive to shape a healthcare environment in the UK built on patient choice could actually be endangering the National Health Service’s fundamental principle of equality, a Harvard University researchers has claimed.

In a letter to the British Medical Journal, researcher Adam Ali points out that if patient choice is at all possible then differences in the quality of care must exist, and that some are therefore receiving poorer quality services that informed patients would not choose.

A health system built on choice will only further deepen nationwide inequalities in care, he says, as some patients will be ‘better equipped’ to make informed choices than others.

According to Ali, those better positioned to choose services are most likely to be from the higher end of the social spectrum and, as better educated people are also more likely to be politically active, he claims the government’s drive to increase patient choice is “an effective way of scoring political points under the guise of making the NHS fairer”.

But a spokesman for the Department of Health told PharmaTimes UK News that choice does indeed support the principle of equality in the NHS and is fundamental to the delivery of a truly patient-centred NHS. “It gives providers the incentive to tailor services to the needs and preferences of patients which, in turn, will lead to better outcomes and the reduction of health inequalities”, he said.

Furthermore, he stressed: “Not only does it enable patients to be involved in their healthcare but, in the long-term, it should improve the overall quality and suitability of NHS services. This will bring about a net gain for everyone no matter their ethnicity, socioeconomic status, religion, gender or willingness and ability to choose.”

In support of the DH’s line, the spokesman pointed to research showing that people from disadvantaged groups support choice and make choices. The 2005 London Patient Choice Pilot, for example, showed that 80% of people on lower incomes and 78% of the unemployed expressed a preference to choose an alternative treatment provider, compared to 65% of the general population.

Digital push driving inequalities?
Meanwhile, the government’s push for local health services information to go digital could also be fuelling health inequalities, suggest researchers at Birmingham University.

The majority of health information for patients is online but a third of UK households do not have the Internet and a fifth of the population has problems reading, the report by the University’s Health Services Management Centre points out.

According to report author Jo Ellins, evidence has shown that alternative ways of delivering information – such as telephone helplines, digital TV and community education programmes - are far more successful at reaching these groups than online methods, such as the NHS Choices portal.

The NHS recognises the importance of information in supporting patient choice, Ellins notes, but warns that “the way in which this information is currently provided restricts opportunities for informed choice to more educated and affluent patients,” and that there is “a very real danger that this is sustaining, or even increasing, health inequalities.”