From next April, NHS patients in England will have more freedom to choose where to go for healthcare, the government has announced.
From that date, when patients are referred for selected services, usually by their GP, they should be able to choose from a range of qualified providers, which could be from the NHS, the independent sector or voluntary and third-sector organisations.
Currently, such choice is only available in non-urgent hospital care, such as hip and knee replacements, removal of a cataract or hernia repair. However, from next April it will be extended to the following community and mental health services - services for back and neck pain, adult hearing services in the community, continence services (adults and children), diagnostic tests closer to home, wheelchair services for children, podiatry services, leg ulcer and wound healing and talking therapies.
Every area across England will be expected to offer more choice in a minimum of three services by September 2012, either from the recommended list or for another community or mental health service that is a high local priority. The number of services will be expanded further from April 2013.
Commenting on these developments, Health Secretary Andrew Lansley said there is often confusion about these policies - "a mistaken idea that competition is there for the sake of it, or to increase the independent sector's role in the NHS."
But what it is really about, he said, is "children getting wheelchairs more quickly. It's about people with mental health conditions choosing to receive their care somewhere closer to home. It's about older people being able to choose a service that will come to their home - perhaps the vital difference between staying at home or having to move into care."
"We are taking a phased approach, offering choice for services where it will improve outcomes," added Mr Lansley.
The Department of Health has also published its official response to the consultation on this issue, which notes that:
- over half of respondents agreed that mental health and community health services are the best services to offer more choice from April 2012;
- the policy will be implemented more slowly than was originally planned;
- providers will be paid a fixed price determined by a national or local tariff, with competition on quality, not price;
- a national qualification process will be established to ensure that providers meet NHS quality standards, to minimise bureaucracy and reduce transaction costs; and
- a national directory of qualified providers will be created to inform commissioners and patients.
Any providers wanting to offer services to patients will be subject to a qualification process. They will need to be registered with the Care Quality Commission (CQC), where appropriate, and licensed by the regulator Monitor after 2013. They will need to accept NHS prices.
The new arrangements will never be appropriate for some services, for example emergency ambulance admissions or A&E, says the Department.
Commenting on the announcement, Hamish Meldrum, chairman of council at the British Medical Association (BMA), said that while the Association supports greater choice for patients, it will - in an NHS with finite resources - always be limited.
"What we would question is the assumption that increasing competition necessarily means improved choice. When competition results in market failure in the NHS, the ultimate consequence is the closure of services and the restriction of choice for the patients who would have wished to use them," Dr Meldrum warned.