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Alan Milburn, the health secretary, promised patients more control over the timing of their operations yesterday in a speech which launched a raft of NHS reforms and further details of the long-awaited national cancer plan. Guardian 28 September 2000.

Labour's NHS power shift John Carvel Guardian Society Wednesday April 25, 2001

Demand the right not to choose. Given the choice, the middle class will monopolise the best services. Roy Hattersley Monday June 10, 2002 The Guardian

All patients in need of an operation will be able to choose when and where they are treated, under radical plans to cut waiting lists announced by the government today. David Batty Tuesday February 11, 2003

Who could be against choice in public services? Gordon Brown, for one. Last week in a detailed analysis, he set out why consumers were not sovereign in health care. Leader Wednesday February 12, 2003 The Guardian

The NHS intends to put patients in the driving seat. But how far can choice be allowed to drive the market, asks Peter Davies. Wednesday February 26, 2003

Cheap choices cost dear. Malcolm Dean Wednesday June 11, 2003 The Guardian

NHS hospitals could start advertising for business as they compete to attract patients under the government's policy of increasing patient choice. Tash Shifrin Monday July 14, 2003

Within two years all NHS patients in England will be given a choice of at least four hospitals for any treatment recommended by a GP under plans for a huge injection of consumer values into the health service announced yesterday by John Reid, the health secretary. John Carvel, social affairs editor Thursday July 17, 2003 The Guardian

Nearly half the public does not understand the patient choice scheme, introduced as a flagship element of the government's NHS reforms, research has revealed. Wednesday September 3, 2003

Labour's leading moderniser Alan Milburn will today argue that the government can defuse the row over extending choice in the public services by giving a much greater role to the voluntary sector. Patrick Wintour, chief political correspondent Wednesday November 12, 2003 The Guardian

The government is set to announce a further expansion of choice for NHS patients today, as NHS leaders have breakfast with Tony Blair. Tash Shifrin Tuesday December 9, 2003

Q&A: patient choice. The health secretary has presented parliament with plans for the next phase of the government's NHS reforms. Tash Shifrin explains the background. Tuesday December 9, 2003

Health secretary John Reid has announced plans for a huge increase in the use of private sector provision in an effort to improve patient choice. Here some of the leading voices on the issue offer their thoughts. Tash Shifrin Tuesday December 9, 2003

A cultural revolution in the NHS to put wishes of patients before the convenience of professionals was promised by Tony Blair yesterday as the government launched a white paper offering choice from the cradle to the grave. John Carvel, social affairs editor Wednesday December 10, 2003 The Guardian

Harry Cayton's NHS patient choice white paper proposes far-reaching solutions. He tells John Carvel why the public must now be given power. Wednesday December 10, 2003 The Guardian

Building on the Best: Choice, Responsiveness and Equity in the NHS December 2003 Department of Health downloaded file

The NHS is to advertise in papers from tomorrow in an effort to drum up more 'business' for its London patient choice programme. Since the programme launched in October 2002, only just under 60% (7480) of the 12,500 patients offered elective surgery at an alternative treatment centre have accepted. Orla Delargy Thursday February 5, 2004 The Guardian

NHS patients want more involvement in decisions about their condition and treatment, but few think that having a choice of hospital - a flagship government reform - is important, research revealed today. Tash Shifrin Tuesday April 6, 2004

The government's health advisers say doctors should perform fewer caesareans. But are they trampling on the right of women to choose how they give birth - or protecting mothers and babies? And is anyone really 'too posh too push'? Madeleine Bunting reports. Thursday April 29, 2004 The Guardian

If women can have abortions on demand, is it right to deny them caesareans? Here is an awkward question to embarrass health ministers, especially given the emphasis they have placed on expanding choice in the NHS. Leader Thursday April 29, 2004 The Guardian

Hospital doctors have accused the government of using the concept of patient choice as a "smokescreen" to disguise its intentions to privatise the NHS. Debbie Andalo and agencies Thursday June 10, 2004

Doctors' leaders warned yesterday of a rash of NHS hospital closures after the next election as foreign healthcare corporations scoop up more contracts to treat patients from the waiting list. The British Medical Association said the government was engaged in a covert programme to privatise the health service under the guise of giving patients more choice. As treatment switched to the foreign-owned companies, some NHS hospitals would go to the wall, senior doctors forecast. John Carvel, social affairs editor Thursday June 10, 2004 The Guardian

The health secretary, John Reid, briefed the cabinet yesterday on his five year plan for the health service, the first of a series of long-term policies to be announced in the next few weeks. Patrick Wintour Friday June 18, 2004 The Guardian

Hospital bosses voice concern over key NHS policy. Tash Shifrin Wednesday June 23, 2004

Pulling apart the latest Labour and Conservative policy announcements on health has not been easy. "Choice" is the mantra for both parties. But just how much choice will there be, and for whom? Ros Taylor and Matthew Tempest Thursday June 24, 2004

NHS hospitals which fail to meet the challenge of competition being introduced into the health service will be closed, the government said yesterday in its five-year plan to turn downtrodden patients into savvy consumers. John Carvel, social affairs editor Friday June 25, 2004 The Guardian

Tony Blair and Michael Howard are staking their political fortunes on the notion that patients want more choice. But do they? John Carvel Friday June 25, 2004 The Guardian

I'm a patient, not a consumer. Choice sounds seductive, but it's the last thing you want if you are ill. Jenni Russell Saturday June 26, 2004 The Guardian

Dignity should be the first choice. Politicians offer us healthcare options without thinking about our welfare. Jo Revill Sunday June 27, 2004 The Observer

Doctors today condemned a government scheme to offer patients a choice of hospitals as a smokescreen for "creeping privatisation" of the NHS. Delegates at the British Medical Association's (BMA) annual conference backed a motion that declared the patient choice initiative did not deliver real choice and was wasteful of NHS resources. David Batty Monday June 28, 2004

BMA conference delegates condemned the government’s initiative to increase patients’ choice as failing to deliver real choice to patients and voted overwhelmingly against the expansion of private treatment centres, which they said were draining resources from NHS hospitals. Doctors condemn "patient choice" initiative as no real choice at all. Llandudno Zosia Kmietowicz BMJ 2004;329:14 (3 July), British Medical Journal

Charles Kennedy turned on Labour and the Tories yesterday and warned that their recent pledges to introduce "choice" in the public services were in danger of amounting to "empty rhetoric". Nicholas Watt, political correspondent Wednesday June 30, 2004 The Guardian

The health secretary, John Reid, today staged a press conference to set the announcement of 10 more foundation hospitals in the context of a renewed government offensive on patient choice. Tash Shifrin and agencies Thursday July 1, 2004

The health secretary, John Reid, today unveiled a new partnership between the NHS and the private sector with the aim of improving patient choice and satisfaction. More than 100 NHS trusts will form public-private partnerships with six corporations, including the retailer Boots, the pharmaceutical giant Pfizer, the makers of Viagra, and the software company Oracle. The firms will contribute about half of the £4m project costs and time and expertise of their customer relation specialists. Mr Reid said the aim of the project was to transform the NHS into "a public service built around the convenience of the individual". David Batty Wednesday July 7, 2004

Politicians talk about more options for patients - but they are making the NHS worse, not better, says junior doctor Catherine Blake. Tuesday July 20, 2004 The Guardian

Patients will be able to get prescription medicines over the internet, by mail order in 24-hour supermarkets and in out of town shopping centres after a relaxation of the rules controlling the location of pharmacies. The new rules, announced today by health minister Rosie Winterton, will prepare the ground for more widespread use of the internet to order medicines when electronic prescription services currently being piloted by the NHS are extended across the country. Tash Shifrin Wednesday August 18, 2004

Pregnant women will have the right to a Caesarean birth on the NHS even if there is no medical reason for it, say government experts who have backtracked from plans to restrict the operations. The National Institute for Clinical Excellence (Nice) has issued a clarification of a recommendation it sent out earlier this year, which was aimed at curbing the soaring rates of Caesareans. It told patients' groups that a woman's decision should be respected, even if two doctors disagree with her request for a Caesarean. Jo Revill, health editor Sunday August 22, 2004 The Observer.

Department of Health (DoH) officials today confirmed that patients were set to be offered operations in private hospitals as one of four or five treatment options - but said the policy had been "common knowledge" since the choice policy was first announced. Tash Shifrin Monday September 20, 2004

Today the Labour conference turns its focus on to health. Successive Tory leaders have taunted Labour for allegedly failing to restructure the NHS. Nothing could be further from the truth. The challenge facing Labour is not that it has done too little to change the NHS, but that it has done too much. Multiple reforms are now bumping into each other, exposing goals which ministers clearly wished to keep out of the spotlight. Malcolm Dean Wednesday September 29, 2004 The Guardian

A £6bn investment in computer systems for the NHS was in danger of foundering last night after doctors' leaders said it would put patient confidentiality at risk. The British Medical Association told GPs to exercise caution before joining trials of the Choose and Book electronic appointments system, which is designed to give patients more control over the time and place of hospital treatment. John Carvel, social affairs editor Tuesday November 23, 2004 The Guardian

The government's pledge to give greater patient choice is an excuse for introducing a healthcare competition which the NHS is being set up to lose, doctors warned MPs today. James Johnson, chairman of the British Medical Association, warned that core hospital services could be hit by creating a healthcare market. Appearing before the public administration's committee's inquiry into choice in public services, Mr Johnson said: "If a hospital loses funding because it is less popular than another, that can have consequences for patients. What happens to core services that don't fit easily into the marketplace model like accident and emergency?" Matt Weaver Thursday November 25, 2004

Government efforts to increase patient choice by offering private sector provision could drive NHS hospitals into financial meltdown, doctors warned today. The British Medical Association (BMA) claimed the twin-track government policies on hospital funding and patient choice could see hospitals close as they are forced to compete for custom with other public and private hospitals. Under the government's choice agenda, patients will be offered a range of different hospital providers for an increasing number of treatments, including at least one private hospital option. Hélène Mulholland Tuesday November 30, 2004

The NHS faces a wave of hospital closures caused by the government's plans to extend patient choice, doctors' leaders said yesterday. The British Medical Association said hospitals that did not attract enough patients would be bankrupted under the system of payment by results, to be introduced in England in April. A hospital losing less than 10% of its patients to rival NHS or private sector establishments could be forced to shut, depriving an area of essential cover, the BMA said. John Carvel, social affairs editor Wednesday December 1, 2004 The Guardian

Tony Blair is backing plans to extend the New Labour agenda of wider consumer choice to the elderly, by offering pensioners the option of picking their own meals-on-wheels or care homes rather than relying mainly on local authority services. But behind the details of social service provision lies a battle between the Blairites, who believe that consumer choice is the best way to drive up standards in schools, the NHS and welfare, and Labour MPs and ministers, including Gordon Brown, who mistrust the market-orientated road to public service reform. Michael White, political editor Monday December 27, 2004 The Guardian

The NHS is no place for choice. Letters Monday February 7, 2005 The Guardian

NHS turns to man from Comet. John Carvel February 24 2005

Government make £14bn available for person-centred care. Nick Pandya Saturday April 2, 2005 The Guardian

Nurses are being turned into sales staff under the government's policies on choice in health, the head of the largest nursing union warned today. Hélène Mulholland Monday April 25, 2005

From the schools we select for our children to the hospitals where we go for surgery, James Meek investigates how - whether we notice it or not - the issue of choice has come to overshadow our everyday lives. Monday May 2, 2005 The Guardian

Tony Blair today promised a white paper on personalised health care would be published this autumn. Debbie Andalo Thursday May 12, 2005

Leading questions. Gerry McSorely, president, Institute of Healthcare Management. Mark Gould Wednesday May 18, 2005 The Guardian

The biggest hospital building programme in the history of the NHS may be producing expensive "monuments" that are no longer needed in the new era of patient choice, a senior Department of Health official has warned. Bob Ricketts, head of a programme to accelerate patients' access to treatment, raised fears about the inflexibility of about £18bn worth of contracts given out under the private finance initiative (PFI) that will lock NHS trusts into paying for the new facilities for at least 30 years. John Carvel, social affairs editor Thursday June 9, 2005 The Guardian

Family doctors today voted to oppose the 'choose and book' system for hospital appointments that is a key part of the government's NHS reforms. Choose and book is designed to give patients a choice of time, date and place for a first outpatient appointment - and allow it to be booked electronically through a computer system. The government has also pledged that by the end of this year, patients will be able to choose from four to five hospitals - one of them in the private sector. Tash Shifrin Friday June 17, 2005

NHS managers misread the balance of power with patients at their peril, Paul Corrigan, the former special adviser responsible for key NHS reforms, warned today. Mr Corrigan, who recently stepped down from his role in the Department of Health, told NHS managers that encouraging patients to be more "active" in their care was essential because the "customers" were better placed than service providers to know what they wanted. Hélène Mulholland in Birmingham Thursday June 16, 2005

If the threats to shut down Kidderminster hospital's accident and emergency department lost Labour its seat in the town in the 2001 election, what is the government's new competitive health market going to do in the 2009 election with hospital departments and wards being closed up and down the country? Few people are aware about what is going to happen to the NHS. Labour's plan is far more radical than the internal market that the Conservatives introduced in 1991. While there are more structures in place to protect standards - inspection, clear clinical guidelines and competition based on capacity not price - there is no current plan for a safety net like the one the Tories used to prevent closures and protect the party from political flak. Leader Monday June 20, 2005 The Guardian

A radical shake-up of primary care to make GP surgeries more flexible and patient friendly, including the prospect of specialist GP surgeries for teenagers, is to be outlined today by the health secretary, Patricia Hewitt. People could also register with GPs near their workplace rather than their home as a better reflection of modern lifestyles. Family doctors would also be given greater autonomy to order diagnostic scans rather than having to refer to a hospital. Patrick Wintour, chief political correspondent Thursday June 23, 2005 The Guardian

The health service's head of IT said yesterday he was "all ears" to doctors' complaints about the new £6.2bn acute care booking system, called choose and book. Family doctors at the British Medical Association's annual conference for GPs last week voted overwhelmingly to oppose the system as it is currently designed SA Mathieson Wednesday June 22, 2005

Government plans to allow patients to register with a GP near to their work as well as their home may be doomed before they have even reached the statute books, GP leaders warned today. The British Medical Association (BMA), which represents doctors, has been pushing ministers to allow patients to register with more than one GP since before the last election, according to the deputy chairman of the BMA's GPs committee Laurence Buckman. But the idea never got off the ground because the Department of Health was convinced it would be too difficult to introduce, he said. Debbie Andalo Thursday June 23, 2005

Doctors' leaders launched a rebellion last night against government plans to turn the NHS into a competitive market in which hospitals failing to attract enough patients will go to the wall. The British Medical Association published a poll at the start of its annual conference in Manchester showing patients are anxious to have cleaner hospitals, but have little interest in ministers' plans to let them choose where to have an operation. John Carvel, social affairs editor Monday June 27, 2005 The Guardian

Making medical services more accessible to teenagers is the aim of a pioneering network of drop-in centres provided by Rotherham PCT. John James reports. Wednesday June 29, 2005 The Guardian

Government plans to put the medical records of 50 million patients in England on a national electronic database pose even more of a threat to civil liberties than the ID card scheme, doctors' leaders warned yesterday. The patient care record - part of a £6.2bn programme to develop IT for the NHS - would allow GPs, hospitals and paramedics to access medical information that could save lives. But the British Medical Association (BMA) conference in Manchester was told it might also permit the leaking of intimate details about patients and their families divulged over many years in confidential consultations with GPs and consultants. John Carvel, social affairs editor Thursday June 30, 2005 The Guardian

Tony Blair's plans to give NHS patients a free choice of hospital will not work fairly unless there is free transport and clearer information, four government-funded research studies revealed yesterday. John Carvel Tuesday July 5, 2005 The Guardian

Patient choice in jeopardy as NHS woos private sector. James Meikle, health correspondent Friday July 29, 2005 The Guardian

Giving patients more choice of where and how they are treated could put them at risk, says the consumer lobby group Which?. Increasing private sector involvement in NHS care, introducing minor operations in GP surgeries and blurring the boundaries between nurses, pharmacists and doctors will require more rigorous checks, the report warns. The present system of regulating NHS and private hospitals, medicines, equipment and health professions is complex, fragmented and "ill-suited" for the new health landscape, says Frances Blunden, the principal policy adviser at Which?. James Meikle Monday August 1, 2005 The Guardian

Far from derailing patient choice, the changes set out in Commissioning a Patient-Led NHS will enable the NHS to deliver the government's reforms (Report, July 29). The changes complement the policies of patient choice and payment by results, and the commitment to press on with the NHS foundation trusts programme. This is not the wholesale reorganisation of the NHS - it is about ensuring that power is shifted closer to the frontline. John Bacon Department of Health. Wednesday August 3, 2005 The Guardian

Poor morale among NHS staff implementing a sweeping new IT programme is putting the multimillion pound project at risk, researchers said today. The National Programme for IT (NPfIT) is introducing new technology throughout the NHS, including centralised electronic patient records that can be accessed across England. The aim is for electronic patient records to be introduced in all acute NHS trusts by the end of 2007. Hélène Mulholland and agencies Friday August 5, 2005

Choice must not define what it means to be modern. New Labour's agenda is to make us more efficient slaves of the market. Neal Lawson Friday September 2, 2005 The Guardian

Healthcare professionals will have to use more of their time to help patients make decisions under the government drive to introduce choice in public services, health minister Lord Warner said today. The focus on nurses, midwives and other healthcare professionals to provide patients with ample information on which to base their choices will have a "time and money cost", he told a fringe meeting at the Labour party conference. Hélène Mulholland in Brighton Tuesday September 27, 2005

Jennifer Rankin cites the direct payments scheme as an example of how social services are in advance of the NHS in terms of offering choice and autonomy for clients (Second thoughts, September 21). The scheme looks liberating in theory; in practice, it is being imposed on some service users against their will. Letter Wednesday September 28, 2005 The Guardian

The Department of Health has admitted that not a single primary care trust in England is expected to meet the government target for offering patients an electronic booking service. This will force many GPs to manually deliver the policy on giving patients the choice of at least four or five hospital providers for outpatient appointments by January 1 2006. The so-called "choose and book" project is part of the national health service's £6.2bn IT programme promised by the government to offer an electronic booking service under the patient choice agenda. Hélène Mulholland Friday September 30, 2005

A healthcare entrepreneur has raised more than £100m from the City to kickstart plans to build a chain of private hospitals across England in partnership with hundreds of frustrated NHS consultants. The venture, probably the biggest private investment in hospital construction since the NHS was founded in 1948, has been triggered by the government's plans for patient choice, identified by Tony Blair in his speech to the Labour conference as the big theme of his third term. John Carvel, social affairs editor Monday October 3, 2005

Choice for all users of the NHS is the only way to embed good practice, says Julian Le Grand. Wednesday October 12, 2005 The Guardian

Ideology is driving the health service reforms, rather than New Labour's principle of 'what works'. John Denham Wednesday October 19, 2005 The Guardian

Roll-out of government's flagship electronic booking system for hospital appointments is year behind schedule, NHS chief executive admits to MPs. Welcome to the lunchtime news round up from SocietyGuardian.co.uk Tuesday November 1, 2005

Millions of patients will be able to claim return rail fares from the NHS if they choose to be treated at a distant hospital instead of having an operation locally, the head of the health service in England said yesterday. Sir Nigel Crisp, the NHS chief executive, said it would be possible for a London patient on a low income to select a hospital in Newcastle or Truro without paying a penny towards transport. John Carvel, social affairs editor Wednesday November 2, 2005 The Guardian

Care for carers. Congratulations on Anushka Asthana's article on home carers (News, last week), highlighting the extremely difficult and vital role they play in our society. This is a stressful and heroic job, due to become even harder if state-funded support for carers is to be frozen. When it appears that we are approaching a period of national debate over the balance between taxes and spending, it is useful to be reminded of the human cost of cuts in public funding. In an area where support is already inadequate, local councils would be better focusing their efforts on delivery of care rather than penalising families that need more, not less, support. Matthew Kirk London SE16
Anushka Asthana's searing report throws a sharp light on the government's current mantras for the NHS: choice and contestability. It believes that it can create more choice for patients by opening up NHS services to private providers. The result is that attention and resources are diverted largely to short-term conditions which can be treated quickly and profitably by the private sector. Severely damaged children and other difficult patients, and their carers, are offered no choice at all, and the meagre help they receive is cut even more. That is the kind of thing that happens - inevitably - when the NHS is driven by choice, rather than need. Richard Heller London SE1. Letters to the Editor Sunday November 13, 2005 The Observer

As the December deadline looms, the delivery of the government's flagship patient choice policy is in doubt. The e-booking computer system won't be up and running for a year, many GPs are disengaged from the choice initiative, and hospitals are feeling the financial strain of money following the patient. Technology can be fixed, professionals can be won over, and finances plugged, but the biggest risk of patient choice may be its impact on the under-reported problem of healthcare inequalities. Patient choice risks widening health inequalities, says Joe Farrington-Douglas. Wednesday November 16, 2005 The Guardian

Hewitt tells hospitals with deficits to delay operations. · Minister orders trusts to get finances under control. NHS thinktank warns cash problems may get worse [because of Choose and Book] John Carvel, social affairs editor Wednesday December 7, 2005 The Guardian

Government reforms in the NHS are failing to keep pace with public expectation, according to a report today on attitudes to public services policy. ... The study pre-empts the roll out of patient choice, due in 2006, which will allow all patients a choice of five hospitals for treatment. But the study notes that patent choice is not the terrain most likely to impress the public. "Research show that developments like patient choice might to relatively little to improve overall satisfaction with the NHS," it says. Hélène Mulholland Tuesday December 13, 2005

Patient choice fine in theory, says survey. John Appleby Wednesday December 14, 2005 The Guardian

Balance sheet on choice in the NHS. Letters Thursday December 15, 2005 The Guardian

This rigid market model won't survive the real world. New Labour was right to want diversity and choice in public services, but that has now turned into an unworkable dogma. John Denham Wednesday December 21, 2005 The Guardian

Is choice in healthcare a good thing? A BMJ editorial warns that it might not be. "Will greater choice of providers by primary care services be worth having if it undermines the foundations of a system that works reasonably well at present ? …Unmediated choice will increase inequity because it will favour patients with access to information and transport. This inequity will be magnified if patients in lower socioeconomic groups have lower expectations and less ability - real or perceived - to deal with the choices on offer…The knowledge that they might be making the wrong decision exposes patients to additional stress." It concludes: "The NHS should shift the focus to assisted or facilitated choice, providing experts and tools to help narrow down the possibilities to a manageable number and to offer support to those least able to negotiate their way around the service." Summary by Keep our NHS Public of British Medical Journal 23 December 2005

GPs' online referral scheme "is another national IT disaster", say Tories. Figures obtained by the Conservatives show that in November only 2.7% of GP referrals were booked using the Department of Health's costly IT system, despite the government originally promising that the system would be fully operation by now. Summary by Keep our NHS Public of Daily Telegraph 26 December 2005

The health secretary, Patricia Hewitt, has imposed a review of the biggest hospital rebuilding project in Britain, casting into doubt Labour's multibillion pound private finance initiative in modernising the NHS. Ms Hewitt has not only questioned the affordability of the £1bn plan to rebuild the Royal London hospital in Whitechapel and partly rebuild St Bartholomew's in Smithfield - founded in 1123 and England's oldest hospital, but is also asking whether projects on this scale will best serve patients' needs in an age of rapidly-changing healthcare. Ms Hewitt's decision to question the scheme reflects growing concern about the ability of hospital trusts to bear the huge annual costs of servicing 25-40 year PFI deals at a time when hospitals' guaranteed incomes have been plunged into uncertainty by the new payment-by-results policy. Michael White, political editor Wednesday December 28, 2005 The Guardian

Plans to revolutionise the way patients are admitted to hospital have been attacked as 'Stalinist' by Britain's leading surgeon. Bernard Ribeiro, president of the Royal College of Surgeons, said the system would destroy the professionalism of the NHS and put people's care at risk. As the Health Secretary, Patricia Hewitt, prepares to announce a choice for patients of up to four hospitals to go to for treatment, Ribeiro warned that the professionalism of doctors was being undermined by a target-led culture and the government's 'choice' agenda. He singled out the new £64 million 'choose and book' computer project which allows GPs to make an electronic booking for patients when they need to be referred to a consultant. Jo Revill, health editor Sunday January 1, 2006 The Observer

Patients will from today have a choice of free treatment in up to four hospitals - including one in the private sector - in a change that the government hails as one of the most fundamental reforms since the NHS was created nearly 60 years ago. The move - seen as meeting one of Tony Blair's key pledges for more consumer choice in the public services - is controversial among some Labour backbenchers and was yesterday attacked by the Liberal Democrats and unions, who believe it could force unpopular hospitals to close. John Carvel and David Hencke Monday January 2, 2006 The Guardian

Patients across England are now being offered a choice of hospital for treatment - but it appears that not many know about what is going on in the NHS. Monday January 2, 2006 9:13 AM

The Government's much-heralded patient choice policy has entered a new era as the programme was rolled out across England. People needing treatment will now be offered a choice of at least four NHS or private hospitals, clinics and treatment centres in their local area when they are referred by their GP. But by 2008 the choice agenda will be flung wide open, with ministers promising that patients will be able to choose from any hospital or provider anywhere in the country which meets NHS standards at NHS prices. Concerns remain about the effect allowing patients a free choice of where they are treated will have on the NHS and individual hospitals. There are fears that less popular units could be forced to close due to a lack of patients choosing to go there, while popular hospitals will be overwhelmed and see waiting lists soar. Monday January 2, 2006 9:13 AM

NHS choice will spark advertising war. Hospitals are preparing to launch advertising campaigns to compete for patients that will take up resources and undermine the communal culture of the NHS. Paul Miller, chairman of the BMA's consultants committee, said: "An advertising war is inevitable. This is not speculation - the NHS is already holding conferences about marketing for hospitals. Choice for patients is a good thing but spending NHS resources employing marketing people and buying advertising space is probably not where most people want their NHS resources spent." Summary by Keep our NHS Public of The Independent 2 January 2006

Rift over greater hospital choice. Unions have said that the government's attempts to give patients more choice could have the opposite effect. Alison Kitson, director of nursing at the Royal College of Nursing, said "There is a real danger that creating a market within the NHS could effectively erode choice for patients as the most popular hospitals become overwhelmed, while the least popular sit empty and may eventually face closure. Fewer hospitals mean less choice for patients - and it is the most vulnerable members of society, such as the elderly, who will suffer the most if they cannot access hospital services on their doorstep, leaving them with no real choice at all." Summary by Keep our NHS Public of BBC Online 3 January 2006

Number 10 health adviser calls for greater choice over GP services. Paul Corrigan, Tony Blair's health adviser, has said in a pamphlet that patients should have greater choice in primary care, and should be able to invite new providers in to an area to break the monopoly of GPs. Patients would use petitions to invite in providers -including the private sector, foundation hospitals, specialist clinics and pharmacies - who could bypass PCTs. Closed GP lists would lead to an automatic invitation. Corrigan said that while many patients favour a personal GP, in many areas there is no real choice and people should be able to split their care between different providers in different places. There would be failures that PCTs would have to deal with. The pamphlet comes ahead of the white paper on care outside hospitals, which Patricia Hewitt says will involve additional providers "in parts of the country where there are simply not enough GPs." Summary by Keep our NHS Public of Financial Times 5 January 2006

Confusion reigns over the meaning of choice. Professor John Appleby, chief economist at the King's Fund, has criticised the lack of clarity in the government's choice agenda, saying: "It is worrying that the department is unclear about what sort of choice it is offering." He accused Patricia Hewitt of using inappropriate evidence in her claim that patients want the new choice regime that came in at the start of the year. She bases her assertion on the 2002/ 04 London Choice Project, where 60% of patients who had been waiting for inpatient treatment for more than six months opted for quicker treatment at a different institution. But Appleby, who worked with the DoH analysing the results of that scheme, said it is "not comparable" to offering a choice of places for outpatient appointments, before a patient has been fully diagnosed and before they are waiting for specific treatment. There is also a lack of clarity over the degree to which PCTs would be forced to offer patients the choice of using a private provider. John Reid's original proposals included the requirement, but Lord Warner recently said that "private providers will be included on the menu only if the PCT has a relationship with one." Summary by Keep our NHS Public of Public Finance 6 January 2006

Heart of the matter. A Public Finance leader warns that "pseudo-markets in the public sector need to be handled with care, or the end result could be less choice, not more. That's certainly the situation in Oxfordshire, where more than 50 patients with irregular heartbeats have been removed from the waiting list." Summary by Keep our NHS Public of Public Finance 6 January 2006

Health ministers face a crisis of confidence among GPs and hospital consultants over the £6.2bn programme to build the most sophisticated medical IT system in the world, a Guardian poll of more than 1,300 doctors has revealed. It shows most doctors think the Connecting for Health programme is a waste of money and only 1% feel it is making good progress. Doctors are concerned that patient confidentiality will be compromised when records are transferred to an electronic system open to clinical staff. Only a minority of GPs expect to be using the Choose and Book system for making hospital appointments by the end of the year, despite government assurances that it will be available by then in every family doctor's surgery in England. John Carvel, social affairs editor Tuesday January 10, 2006 The Guardian

In the final days of the old year, the government's NHS reforms took a huge hit with the publication of evidence of the service's widening financial instability. Now, just days into the new year, there comes a second blow: a new survey of doctors that shows plummeting support for the health service's £6.2bn integrated IT programme, the biggest civilian IT project in the world. Three years ago 47% of doctors thought the programme was a good use of NHS resources while 27% thought not; now only 17% say it is while 57% disagree. Leader Tuesday January 10, 2006 The Guardian

Doctors in Bristol are boycotting online booking of NHS surgery. Some doctors in Bristol are boycotting the choose and book system because they say it takes up too much clinical time. One GP said: "The idea of choice is not new - 10 years ago you could chose to have an operation anywhere in the country but that choice was taken away. What this government has done is given back some choice but failed to recognise that it removed it in the first place." Summary by Keep our NHS Public of Bristol Evening Post 9 January 2006

New NHS booking system "a shambles". Essex doctors claim the introduction of patient choice has been a "shambles". Essex Local Medical Committees said that GPs did not have the knowledge to advise on specialists and waiting lists at non-local hospitals and they fear for patient safety under such a complicated scheme, where referrals could become lost in the system. Summary by Keep our NHS Public of East Anglian Daily Times 9 January 2006

Robust monitoring is crucial to patient choice. The monitoring of care provided under the new patient choice scheme in England is poorly structured and variable. A survey of PCTs found that for cataract operations more than half relied on non-specific and service level agreements or patient feedback to monitor the quality of surgery. Summary by Keep our NHS Public of British Medical Journal 13 January 2006

GPs snub choice initiative. There are reports that even where electronic Choose and Book is up and running, GPs are not using it because of the additional time and workload it incurs. In many areas the booklets with details of available choices have not arrived. Birmingham LMC secretary Dr Robert Morley said: "We are carrying on consulting in a clinically appropriate way as we always have done. This arbitrary number is a farce." Summary by Keep our NHS Public of Doctor Update 13 January 2006

Choice booklets delayed. Booklets for the manual Choose and Book system will reach GPs this month, according to health service officials. But the Department of Health had earlier claimed that they were sent out before Christmas. Manual Choose and Book remains unpopular with GPs. Summary by Keep our NHS Public of Doctor Update 17 January 2006

Cancer check delays caused by patient choice. Charles Redman, the top cervical cancer specialist at the University Hospital of North Staffordshire, fears the fast-track referrals that have seen waiting times for colposcopies at his unit slashed to three weeks will be an early victim of the requirement for patients to be given a choice of four hospitals to be referred to for specialist treatment when they visit their GP. He said: "I think some areas may become less efficient because of Choose and Book. My own speciality has just a three-week wait for colposcopy and this is generally not long enough for the Choose and Book process to work." Summary by Keep our NHS Public of Stoke Sentinel 18 January 2006

The conflict over the role of choice in public services - one of the central disputes in Labour's education reform controversy - was laid bare yesterday when a leading Blairite minister argued that choice was the route to securing greater social mobility, but Britain's largest union produced polling evidence to claim the public regarded choice as an irrelevance. The poll, conducted by YouGov for Unison, showed the public mainly wanted well-funded and convenient services, rather than services competing with one another for users. The poll was released by Unison as part of a new year campaign to reverse many of Mr Blair's public sector reforms. Patrick Wintour, chief political correspondent Thursday February 2, 2006 The Guardian

GP asks hospital users to rate performance online. A new website, www.patientopinion.org.uk, has been launched with support from the NHS as a forum for patients to rate hospitals and share their experiences. The costs of the service are to be covered by charging healthcare providers for access to data. The site was founded by Sheffield GP Paul Hodgkin who said: "Patients need to be able to trust Patient Opinion and I also wanted Patient Opinion to be really useful to staff - not just another stick to beat them with. So we made Patient Opinion into an independent, not-for-profit, social enterprise. It is separate from the NHS, but funded by subscriptions from hospitals and PCTs who want to access feedback to improve services." Summary by Keep our NHS Public of Times 15 February 2006

NHS to advertise for patients. Hospitals have been given the green light to spend money advertising for patients by health minister Liam Byrne. He backed Midland hospitals considering buying advertising space to help to attract patients. Heart of England NHS Foundation Trust, which runs Heartlands and Solihull hospitals, has commissioned market research to consider ways of expanding its "market share". The University Hospital Birmingham NHS Foundation Trust has also turned to Opinion Leader Research to identify ways in which it can attract more patients to its superhospital, which could open in 2009. Patient choice and payment by results are driving the policies, as income will now depend on the number of patients treated. Black Country MP John Spellar said the money should be spent on treating patients instead and challenged Liam Byrne in the House of Commons. Byrne replied: "With the introduction of patient choice and payment by results, it is important that patients are aware of the services and options available to them. Therefore, a small amount of advertising is in the interests of both patients and hospitals. The department is developing guidelines to ensure that any public communications are not only honest and accurate, but also appropriate. These guidelines, together with the payment tariff set by payment by results, should deter inappropriate expenditure on advertising." Summary by Keep our NHS Public of Birmingham Post 16 February 2006

Healthcare group advert campaign to target NHS staff. Sweedish healthcare company Capio is to launch a £1m advertising campaign aimed at NHS staff this summer. It will be the first time a private provider has advertised its services to family doctors, consultants and NHS managers to increase its NHS business. The company says that in future it is likely to advertise direct to patients. Foundation and NHS trusts in London, Birmingham and elsewhere are appointing marketing directors and business development directors. Mary Anne Cooke, business development director for United Bristol Healthcare Trust, said that the hospital had to expand services and that "if we don't get this right, we will have to downsize." "I can see the day coming when we will advertise direct to patients. The main problem is that it takes resource, and a lot of people feel very uncomfortable about it…But if we don't have any money coming in we can't look after patients at all." Unison has called the use of taxpayers' money for advertising "disgusting" and "scandalous". Summary by Keep our NHS Public of Financial Times 16 February 2006

Choice needs to be carefully managed. In a letter to the FT the policy adviser of Which ? comments on Julian Le Grand's lecture where he advocated choice in the NHS, saying: "Which?'s own 2005 research shows that the public's appetite for choice is inconsistent and variable, often depending on their personal circumstances, state of health and the types of choice they are offered. For some choice is an unwanted and overwhelming burden… Prof Le Grand's use of evidence to back up his arguments is selective to say the least; for example, the Department of Health research he alluded to did show that three out of four people in England want more say in their treatment, but just three in 10 thought a choice of hospital or doctor was important. If choice in healthcare is to work effectively…proper information and support are needed particularly for those people with significant health needs, on lower incomes or with poor literacy skills. The current scheme for offering choices for elective surgery does not include this level of help and Prof Le Grand is wrong to suggest otherwise…. Unless choice is very carefully managed, it may well deliver unintended consequences that fail to meet some of the public's basic expectations." Summary by Keep our NHS Public of Financial Times 24 February 2006

Not convinced that greater patient choice improves equity of access. In a letter to the FT Professor John Appleby responds to Julian Le Grand's use of the British Social Attitudes Survey to bolster the latter's arguments for choice: "As one of the authors of the analysis of the 2004 British Social Attitudes Survey that Julian Le Grand states as underpinning his arguments that choice enhances equity in healthcare, perhaps I could offer a slightly more qualified view… While I can see many advantages in promoting greater patient choice, I remain to be convinced of its power to improve equity (of access, or of health outcome)… What we need is evidence of how the government's particular policy on choice (and competition) affects the key founding objective of the National Health Service: equality of access for those in equal need." Summary by Keep our NHS Public of Financial Times 01 March 2006

Warning on choice 'spin'. The Department of Health head of strategy has warned that hospital marketing in the era of patient choice will need to focus on reputation rather than "spin and PR". Will Cavendish said Marketing and advertising are "healthy responses" to reforms like choice and payment by results, but must not mislead patients. Summary by Keep our NHS Public of Health Service Journal 2 March 2006

NHS's £6bn IT programme 'in need of significant changes'. Richard Jeavons, the man charged with implementing the NHS IT programme, has said it needs "a new operating model" and is being "refreshed" in the light of government policy changes since its launch in 2002. The government has moved to introduce a supplier market, bringing in private sector operators, competition, foundation trusts and patient choice and there are "significant changes arising from that". 'Choose and book' should have been in widespread use by last December but the target for full implementation has now moved well into next year. Patricia Hewitt has said that even by August only 1m of the 13m first outpatient appointments made annually will have gone through the system. Sir John Bourn, head of the National Audit Office, said the programme has become "a focus of dissension" within the NHS. Summary by Keep our NHS Public of Financial Times 21 March 2006

NHS lead knocks referral centres. Referral management schemes are contrary to the aims of the government's patient choice initiative, according to the government's own IT specialists. The NHS Connecting for Health team has said the schemes go against the aims of choose and book, making it more cumbersome than it needs to be. GPs have been advised by the Medical Defence Union to have their own referral tracking system in place to avoid potential medical negligence claims over delays following referrals. Summary by Keep our NHS Public of DoctorUpdate 31 March 2006

Blair is accused of wrecking NHS with confused policies. The former chairman of the University Hospital of North Staffordshire, the hospital forced to sack 1,000 staff due to its £15.5m debt, has accused the Government of wrecking the NHS with bureaucracy and contradictory policies. Calum Paton said Tony Blair had "snatched defeat from the jaws of victory" on state-funded health. He said the Prime Minister had "not a hope in hell" of achieving his stated aim of a maximum 18 weeks between a patient's first GP visit and having an operation. He said: "The Government has suffered from drastic policy confusion and what I call initiativeitis, bringing out up to three initiatives a day that cost a fortune to run." Encouraging Trusts to work independently to promote choice but at the same time telling them to promote local collaboration had caused confusion. SHAs "crawl to ministers and refuse to tell them the full extent of the financial crisis". He slammed patient choice, saying "patients in Staffordshire don't want a bus trip around the country to go to hospital, they want good local services. If the Government had taken a harder look at strategy at the outset it could have spent the same and got much better health care." Summary by Keep our NHS Public of Telegraph 5 April 2006

The Government has insisted that patient care remains of paramount importance in the NHS amid reports of secret plans to ration GP referrals and save money. According to The Times, patients are being denied appointments with consultants in a systematic bid to ration care and balance the books. It cited leaked documents showing that, despite the Government's Patient Choice agenda, barriers are being erected, limiting GPs' rights to refer people to consultants. The documents reveal plans by health trusts across London to establish panels to "monitor" how many patients are referred to hospital by doctors, it reports. Local trusts have been told they must cut their referral rates to those of the lowest 10% nationally - saving £25 million a year in the capital, it added. Consultant-to-consultant referrals are also being limited, denying many patients a second opinion. Further targeted are patients who use accident and emergency services for care that could be provided by GPs. The Times reports that emergency care staff in A and E departments will "redirect" up to 70% of patients back to GPs or walk-in centres. And payment will be withheld from hospitals who treat patients who should have been sent to GPs. The leaked paper, Pan London Demand Management Arrangements, is still in draft and was produced by the London Transition Team, led by senior NHS manager John Bacon. Friday April 7, 2006 8:23 AM

Computing professors have told MPs they have serious technical doubts about the NHS's proposed £6.2bn computer system. They have called for an inquiry into the plan, intended to link English health centres and provide electronic patient records. It is also meant to allow electronic appointment booking, but is already more than a year behind schedule. John Carvel Tuesday April 11, 2006 The Guardian

Computer experts have written to MPs calling for an independent review of the NHS's £6.2 billion IT scheme. The National Programme for IT (NPfIT) will link more than 30,000 GPs in England to almost 300 hospitals by 2012. It involves an online booking system, a centralised medical records system for 50 million patients, e-prescriptions and fast computer network links between NHS organisations. Tuesday April 11, 2006 7:38 AM

Patient choice and PBC incompatible. Patient choice and practice-based commissioning are not compatible, according to a report by the University of Birmingham Health Services Management Centre and the NHS Alliance. Conflict between the two flagship Government policies will arise because patients will often ignore GPs' decisions on how or where they should be treated. It also called for clarity on whether patients should be given a choice of primary care providers as well as hospitals. Dr Richard More, a GP in Yeovil, Somerset, said: "Patient choice embodies the thought you can have what you want and PBC implies you can have what we've got." Summary by Keep our NHS Public of Pulse 11 April 2006

Rationing the health service. In a letter to the Times, Chairman of the BMA James Johnson writes: "referral management centres are completely at variance with the Government's patient choice policy (letters, April 11 and 12). These initiatives erect a barrier between the doctor who has seen the patient, usually the GP, and the consultant best placed to look after the patient's needs." Summary by Keep our NHS Public of Times 13 April 2006

Spoilt for choice. King's Fund chief economist John Appleby challenges Julian Le Grand's claims for patient choice. He says: "Too often in debates about Patient Choice, what is being chosen and the necessary limits to choice, are left indeterminate. While NHS patients do not face the financial consequences of their choices, the NHS does: it has a finite budget… Le Grand builds a case for choice based partly on a description of a failing NHS, with long waiting times, haughty professionals and dastardly monopolistic practices. But it is too easy to slip into hyperbole, exaggerating the decrepitness of the current situation, when you have a new policy solution to promote." King's Fund research found that those with formal educational qualifications placed a higher weight on the impact of treatment on their health than those without qualifications, raising the possibility that the better educated will choose better hospitals, meaning "it is hard to see how the less well educated (and poorer) will benefit." Appleby contends that many of the benefits claimed by Le Grand for patient choice are actually down to other changes. Summary by Keep our NHS Public of Public Finance 14 April 2006

Missing the targets. Out of 26 of the Government's key health targets, 12 have been revealed as having little prospect of being met by the intended date of 2008 unless urgent remedial action is taken. These are: Improving diagnostics - choice of CT or MRI scan; waiting times for cancer treatment; halving MRSA rates; "Patient choice", the promise of a choice of hospital, including the option of going private, for certain procedures if waiting time targets are exceeded; choose-and-book system in GPs surgeries for hospital appointments; reducing inequalities in infant mortality rates; reducing inequalities in infant mortality rates; [public health] cutting smoking rates in poorer households; reducing inequalities in life expectancy; cutting teenage pregnancy rates; cutting childhood obesity rates; improving access to genito-urinary clinics; meeting the financial forecast - spending targets. Summary by Keep our NHS Public of Times 25 April 2006

The politics column - Allyson Pollock. In the New Statesman's main political column, Allyson Pollock writes: "According to Patricia Hewitt the NHS has had its best year ever. So why is the Royal College of Nursing threatening industrial action over cuts and closures, and why did the annual conference of Unison, traditional Labour supporters, greet the secretary of state with heckling? In her words, "the NHS must modernise or die". So why, from Surrey to Manchester and from Gateshead to Shropshire, are local people banding into hospital action groups and "Keep our NHS public" campaigns in an effort to defend the health service ? The chief targets for cuts are mental health services, palliative care, older people's care and emergency hospital care, yet Hewitt maintains, to general derision, that quality will not be affected… Pay accounts for 60-70 per cent of NHS hospital budgets, but pay awards accounted for less than 30 per cent of the new money and should have been absorbed easily. Nor was greed involved; the increases returned NHS pay to previous levels after years of pay freezes. The hourly rate of the lowest-paid rose initially from £5.16 to £5.67 an hour; medical consultants got increases of 4-5 per cent a year, taking them to averages of between £75,000 and £95,000, while managers - their numbers swollen by the complications of marketisation - got 7.5 per cent more last year. The real reason for the decision to axe in excess of 13,000 clinical staff and 1,000 NHS beds, plus associated services, is market-oriented reforms such as "choose and book", "payment by results" and foundation hospitals. Hospitals and services are required to behave like stand-alone companies, competing with each other and private corporations for income and patients… The government plans to hand over most of the NHS budget to the private sector through "practice-based commissioning". Under this policy, local PCTs will eventually contract with for-profit companies such as the US-owned UnitedHealth Europe to provide GP services… The Prime Minister asserts that the reforms are bearing fruit, and so they are - for "investors" such as the lucky shareholders of Norfolk and Norwich and Bromley PFI hospitals, who received a windfall of more than £500m within months of the new hospitals opening. But the PFI has been less "fruitful" for local people, who have seen a quarter of beds closed and clinical staff and community provision cut. A large part of hospital trust deficits is due to PFI debts, running at £1.5bn a year… And then there are the costs associated with establishing and operating a market - costs the NHS was explicitly designed to avoid: these are for invoicing, marketing, advertising, drawing up hundreds of thousands of contracts, legal disputes with contractors and rival hospitals, and using management consultants… And though NHS hospitals remain responsible for balancing their books, the government has ensured that the only way they can do so is by cuts, closures, the sale of land and buildings - and more privatisation. Some foundation trusts are entering joint ventures with companies such as the Hospital Corporation of America, providing care to private patients in what were previously NHS beds. Others are charging NHS patients for "extra" care: Queen Charlotte's and Chelsea NHS hospital has introduced a fee of £4,000 for one-to-one midwife care - once the NHS standard - and the government is allowing it. The less fortunate hospitals - if that is the right word - are closing services and sacking staff. Is this what the English patient needs or wants ?" Summary by Keep our NHS Public of New Statesman 2 May 2006

If this is Patients' Choice then may heaven help us all! "Crisis: What NHS crisis?" Daily Mail headline - Monday April 24. The above headline has compelled me to write to you. I have had several hospital appointments over the last few months and been told I now have Patients' Choice to choose when I attend and at which hospital. The reality of all this is that in order to make an appointment , my doctor handed me a print out of my "instructions". I was to wait for at least four to six weeks to see if I was contacted. If not, I was to phone the number indicated. This was just to check that I was in the system. Fortunately, someone did telephone me before the time was up but only to tell me "they" would be expecting me to telephone "them" within the next couple of days and I was given a reference number to quote. I was strongly urged to telephone within this time period as my call would be expected. I did this immediately and couldn't believe how long it took her to make one appointment. I wasn't "given the choice" of appointment, but given a date and asked if this would be convenient. As it happened, it wasn't, so after another lengthy wait, another date was offered which I accepted. I had already been informed that I had the choice of four hospitals, St Cross, Walsgrave, Coventry and Warwick and quite frankly I cannot remember the name of the other one. However I was told that my appointment would be at the Hospital of St Cross. As this was convenient, I duly accepted. More recently I have received a communication asking me to attend Coventry and Warwick for a kidney CT scan, at 10.15am. I duly telephoned the appointments clerk and said that as I didn't drive, I would have difficulty in getting there for that particular time and could they arrange transport? She said that it was up to my GP to do this. My GP said that unless I was disabled, I would have to make my own way there. I explained I didn't drive but he said there was a bus service. I telephoned Stagecoach who said they do not have a bus that goes directly to the Coventry and Warwick, only Walsgrave. However, if I made my way to Coventry the bus would stop very near to Pool Meadow and it was only a ten minute walk to the hospital. I had previously been told by the clerk at the hospital that if I could get to Pool Meadow, the hospital was only a five minute walk! So far, it has become a ten minute walk! So I am now in the position of not choosing my appointment time/date or the hospital, because obviously St Cross does not have a CT scanning machine. I have no transport but because I'm not disabled, I must make my own way there. I'm prepared to go by bus but there isn't a direct service (Ministers please note, you keep telling us to use public transport and this is precisely why we don't!) As I have just got divorced, am in the middle of moving house and although not obviously disabled, I am 63 years of age, suffering from arthritis, I felt that the whole procedure was just too much, so I have cancelled the appointment for the time being and been told that I will be put back on the waiting list. I am at present on pension credit but once my flat is sold I will have money from my divorce settlement and will be able to afford to pay for a taxi to take me to the hospital. If this is Patients' Choice and if is the Health Service at its best, so help us all! Mrs Wendy Law, Ash Court, Bilton, Rugby. Letter in Rugby Advertiser 4 May 2006. [West Midlands South Strategic Health Authority]

GPs must find lost e-booking patients. Thousands of patients who have been told by GPs to book their own appointments under Choose and Book have become lost to the system. Official figures suggest that around a quarter of a million appointments have been booked under the C& B system to date. But the Department of Health has admitted that, although they have been sent reminder letters, about 11,600 patients (4.6%) who have received 'unique booking reference numbers' have not gone on to book appointments online or by phone as intended. Some doctors have dubbed the service 'Choose and Lose' as a result. Summary by Keep our NHS Public of Doctor Update 11 May 2006

The price of everything. David Janner-Klausner argues that introducing a market into local health provision can in theory increase user 'choice'. But in practice the most likely result is that a few giant firms will end up running all the services in ever-larger areas. He writes: "There is a risk that the mechanisms introduced to increase choice will harm the very communities that Le Grand argues would benefit most from it. The point is not only to provide choice, but also to understand the nature of it, including who the operators are, whom they employ and whether the competition between them will be real…The reality will be the emergence of a small number of suppliers, awarded ever-larger contracts. A similar consolidation has taken place in the bus market following deregulation…For smaller companies, training, innovation and participating in bidding processes costs proportionately more than for larger ones. If they need to invest to fulfil a contract, they are likely to be considered a risky prospect by lenders because their income streams are not as diverse as those of larger providers. If they are charities, their ability to assume risk is even more limited…if commissioners try to include knowledge-sharing clauses in contracts, they are likely to find that contractors put a price on sharing their intellectual property with competitors, if they are willing to do so at all. This will make market-based provision more expensive and will slow down innovation when the goal is to speed it up…Since the government is committed to developing local markets, the likely outcome is that larger companies will have the edge. Furthermore, commissioners will be tempted to get together and offer larger contracts, as this can cut costs. Smaller companies will lose out and agglomeration is almost inevitable. The impact on costs and quality of outcomes is unclear to say the least. Summary by Keep our NHS Public of Public Finance 12 May 2006

PM warns Brown: 'If I am deposed I won't back you'. Tony Blair has said to Patricia Hewitt: "We must continue the pace of reform by improving the choices that patients have within the NHS. We know this empowers patients and, through links with payment by results, drives improvement and value for money. We must therefore continue to expand the effect of choice and payment by results." Summary by Keep our NHS Public of Independent 15 May 2006

Patients get right to elite treatment. Patricia Hewitt is to introduce reforms encouraging patients to bypass local NHS hospitals to be treated at elite foundation trusts and private treatment centres across England. As an acceleration of the government's attempts to create more competition between hospitals, patients will be offered the chance to travel to a top-rated foundation hospital anywhere in the country. This reform will add 32 foundation trusts and 21 treatment centres to the choice of four local NHS hospitals, and one private, that patients can already choose from. The health secretary admitted that increased competition could lead to some local NHS services closing. Hewitt also announced that patients will in the future be able to choose surgeons as well. Summary by Keep our NHS Public of Sunday Times 28 May 2006

Choose and Book setback. Most practices are certain to miss the June target to make a quarter of their referrals via Choose and Book. GPs said they had been frustrated in their efforts to hit the target by difficulties with the software and problems linking to hospital systems. Summary by Keep our NHS Public of Pulse 2 June 2006

Patient Choice 'favours the educated'. The government is pressing ahead with an extension to its Patient Choice initiative, despite new evidence from the Department of Health that shows well-educated patients benefit most from the reforms. Since January 1, patients have been able to choose where they receive their hospital treatment from a list of at least four providers. But from this week patients can also choose to be treated at the 32 existing foundation trusts. But research commissioned by the DoH from consultancy Rand Europe, the King's Fund think-tank and City University, London, revealed that Patient Choice risks widening health inequalities. The study surveyed 1,000 people in England who had been referred to hospital over the past five years. It found patients with formal educational qualifications were more likely to choose a hospital with higher clinical standards. Those without qualifications placed less importance on above-average clinical quality. Summary by Keep our NHS Public of Public Finance 2 June 2006

Patient choice on the horizon for primary care. The government has set up a taskforce to investigate how to extend patient choice into primary care. The head of the taskforce, Dr Mayur Lakhani, said he personally believed choice in primary care would revolve around how to supply clinical information to patients to let them make more informed choices and extended surgery opening hours. Summary by Keep our NHS Public of Independent Nurse 5 June 2006

Pressure builds for rethink over C&B. GPs will call for Choose and Book to be suspended next week at the annual LMCs conference. This follows a poll in which more than three-quarters of GPs said the electronic booking system should be subject to an independent review of its technical feasibility. But last week, while Lord Warner conceded that the National Programme for IT would cost at least £16bn more than planned and that national summary care records were more than two years behind schedule, another minister announced plans to expand the C& B programme nationally to include more options for patients. Summary by Keep our NHS Public of Doctor Update 7 June 2006

Little time to remove large blot. Michael White writes: "Like Unison, many consultants (who have also lost autonomy and scope for over-priced private practice, thanks to Labour's reforms) are under the cosh of quasi-market reforms promoted by Alan Milburn, John Reid and now Ms Hewitt. More patient choice, more competition and no guaranteed hospital income, are proving harder than meeting waiting list targets. But voters' patience is stretched and Guardian/ ICM polls report that the Tories are finally ahead on health… Tory and Lib Dem complaints have some force. Labour's constant structural reforms of the NHS have demoralised staff, not least by ending up suspiciously close to the Thatcher reforms demolished by Labour in 1997. Ms Hewitt has less time than she thinks to get it right and to persuade voters to stay loyal to Labour." Summary by Keep our NHS Public of Guardian 8 June 2006

Too little data for patients. Patients want to choose hospitals on the basis of quality of care but there is too little data to help them come to a conclusion, according to a study by the King's Fund and the Rand Corporation. Little data is currently available to the public and patients want results at the level of the individual clinician or clinical firm. The study also found that reductions in waiting time below 10 weeks from GP referral to treatment had no influence on hospital choice. Advice from GPs was important but not an over-riding factor, unless the doctor specifically warned against going to a particular hospital. Summary by Keep our NHS Public of Health Service Journal 8 June 2006

Choose and Book problems with consultants' expertise. Patients are being referred to consultants unfamiliar with how to treat their conditions through Choose and Book. orthopaedic surgeons being forced to leave their own patients anaesthetised on the operating table while they assist colleagues unfamiliar with the techniques needed for the operation. The problem appears to lie with a lack of detail attached to entries in the directory of services held in the system. Dr Jonathan Fielden, deputy-chair of the BMA consultants committee, said: "It often comes down to the exact statement the trust has used to explain the consultant's expertise in the directory of services. This is precisely why we are so worried about Choose and Book." Summary by Keep our NHS Public of Pulse 9 June 2006

GPs propose boycott on commissioning. GPs at the annual LMC conference discussed whether to boycott the 'poisoned chalice' of practice-based commissioning. It was argued that the initiative shifts blame for NHS inadequacies from PCTs to GPs, offloads historic deficits onto general practice and will deprive patients of meaningful choice because it can destabilise local hospitals. Summary by Keep our NHS Public of Doctor Update 15 June 2006

Labour reforms are destructive, says GP leader. Dr Hamish Meldrum, chairman of the GPs' committee of the British Medical Association, has attacked Labour health policies for lack of coherence and detail and for causing the NHS to stagger from one crisis to another. He criticised the recent white paper and said primary care needed to change, "but not the sort of change this Government seems intent upon, which is either change for change's sake or, worse still, unproven, expensive, destructive change. It's a bit like throwing all the crockery in the air in the hope that not only will nothing get broken, but it will all land in a nice, neat table setting." He said GPs feel "no confidence in system reform, no confidence in reformed primary care organisations, no confidence in practice-based commissioning and no confidence in choose and book, no confidence in the chief medical officer and no confidence in the Secretary of State." The Telegraph says his comments "fuelled the uneasy relationship between doctors and the Government." Summary by Keep our NHS Public of Telegraph 16 June 2006

Choose and book target postponed. The department of health has put off the deadline for its targets on using choose and book, but at the same time has doubled the requirements for when it is enacted. If GPs do not meet the new target of 50% of referrals using the system by the revised date of September 2007, then they will have to pay back 'aspiration' money at an average of £1,320 per practise. This news comes as the National Audit Office gave a more positive than expected report on the National IT programme, referring to "substantial progress." Summary by Keep our NHS Public of Health Service Journal 22 June 2006

Choice drive "a sham". Government policies supposed to increase choice in the NHS are actually reducing the options available to patients, GPs at the LMC conference concluded. Referral management schemes were condemned as "an underhand mechanism to ration patient care". Choose and Book also came under fire as "deeply flawed and not fit for purpose" in its current form. Summary by Keep our NHS Public of Pulse 23 June 2006

The chairwoman of an NHS trust is set to attack Government health reforms which, she claims, threaten the future of the service. Debbie Abrahams, chair of Rochdale Primary Care trust, will tell a protest rally in Manchester she is speaking out before the health service reaches "the point of no return". She will say: "I believe passionately in the NHS. For me it is not just about how we organise and provide health care, it reflects and represents the values of our society." And she will continue: "During my period as chair of Rochdale PCT, I have seen a steady stream of national policies introduced - Foundation Trusts, Choice, Independent Treatment Centres and now Commissioning a Patient led NHS - which threaten these values and the future of a NHS that is equitable and free at the point of need." Press Association Saturday June 24, 2006 10:03 AM

Hospital choice is side issue for public. A poll by the British Medical Association has found that hospital choice is a side issue for the majority of the public, secondary to more pressing concerns about the speed of treatment and having a say in health policy. The poll of 1,000 members of the public also found that 55% did not feel that the NHS offered choice. James Johnson, chairman of the BMA, said that, although choice was something that patients were keen on, "the government was wrong to put so much emphasis on the choice of hospitals." He went on to point out that it "would have been far better to increase choice over how people are treated…the public rates the timing of their treatment substantially higher than choosing between hospitals." The poll backs up his claim with only 38% reporting that having a choice between NHS and private services was important to them, and almost half saying choice was not a priority at all. The most important areas of choice found by the poll were the timing of treatment and "having a say in things generally." Summary by Keep our NHS Public of Independent 26 June 2006

"Supermarket" reforms are tearing the NHS apart. Angry doctors at the BMA's ARM have attacked NHS reforms, which they say are breaking apart the NHS. They also criticised their own leaders for not doing enough to stop it. A multitude of speakers criticised the government on a raft of reforms. They condemned patient choice as a sham and accused the new independent treatment centres of creaming off the easy cases, leaving difficult ones for the NHS. They had particular bile for recently proposed funding changes, criticising payment by results under which hospitals only get money for each patient they treat, as well as expressing complete opposition to plans to allow private companies to commission health services on behalf of patients. James Johnson, Chairman of the BMA, questioned whether the US "supermarket" model of healthcare works in a system where "more 'customers' do not mean more profits". He also argued that payment by results created "perverse incentives to keep patients in hospital". He pointed out that it would not take "a financial wizard" to realise that if a private company ran hospitals as well as commissioning services then it would "add up to a licence to print money". He said that at the BMA's instigation, the Government had agreed to a health summit next week. Dr Chaand Nagpaul attacked the squandering of record investment in the NHS and accused the government of "misappropriating billions away from patients' care". Voicing the concerns of many he stated that "now we have the madness of instituting a market in the NHS, with all the wastage in bureaucracy and transaction costs." Summary by Keep our NHS Public of Telegraph 27 June 2006

Choose and Book storm. Choose and Book is being cynically manipulated to ensure 18-week waiting time targets are not breached, according to a GP. Dr Charlie Daniels, a GP in Torquay, said popular hospitals in the region were being removed from the system to ensure they were not overloaded with patients, particularly ENT and cardiology. Summary by Keep our NHS Public of Pulse 30 June 2006

Conference attacks referral centres. Doctors have criticised referral management centres for sending patients for inappropriate treatment to independent sector treatment centres far from their home. At their annual conference in Belfast, BMA representatives backed motions that condemned the use of referral management centres, saying they made a nonsense of patient choice, and called for a restoration of GPs' right to refer patients to a named specialist. Summary by Keep our NHS Public of British Medical Journal 30 June 2006

Herts and minds: £100m hole that could defeat protesters. West Hertfordshire Hospitals trust and East and North Hertfordshire trust are launching consultations on the centralisation of some of their services. With the local health economy more than £100m overspent the talk is of reconfiguration. Both trusts have ambitious plans for centralised facilities funded through the private finance initiative. But the affordability of those projects is in doubt. Both trusts are in deficit and are cutting posts. But PFI projects come with a substantial yearly payment - about 10 % of the cost - that trusts have to meet out of income. Both trusts will also lose some income to privately run surgical centres which will be set up at Hemel Hempstead Hospital and at the Lister in Stevenage. These will carry out much of the elective treatment formerly done by the trusts - and will limit their ability to benefit from patient choice. Some staff and £15m of work will be transferred to the surgical centre. Summary by Keep our NHS Public of Health Service Journal 6 July 2006

Patient choice agenda attacked. Hospital departments will be under threat from the increasing prevalence of independent sector treatment centres (ISTCs) according a leading health professional. Professor John Yudkin, director of the International Health and Medical Education Centre at University College London, said that the choice agenda was creating big problems with dubious benefits. He pointed out that ISTC's work can often be substandard and leave the NHS to pick up the pieces. He also warned that as ISTCs take over more and more simple procedures such as hip replacements and cataracts, their provision under the NHS will disappear. He accused the government of deliberately using the impression that a high proportion of consultants care only about private work to justify the push for ISTCs. He added that his concerns were shared by others at a recent meeting of the Royal College of Physicians. Summary by Keep our NHS Public of Chester Chronicle 11 July 2006

Hospitals 'opt out' of IT system. Some NHS trusts are opting out of offering patients a choice of hospital under a new IT system being rolled out, according to family doctors. GPs said they are unable to book appointments using the online system, Choose and Book, for hospitals with long waiting lists. They said hospitals did not want to exceed the 13-week diagnosis target, and it was interfering with choice. From the beginning of this year, patients have been given the choice of at least four local hospitals for treatment. This has been subsequently expanded to include foundation hospitals and a range of private clinics. In some of the places it has been introduced, such as Yorkshire, the Midlands and the south west, family doctors said hospitals with waits exceeding 13 weeks for diagnostic tests are not being put on the system. Summary by Keep our NHS Public of BBC Online 9 August 2006

PCT denies limiting choice to independent sector. Stockport PCT has denied claims that it is limiting patient choice for orthopaedic patients to the local private sector. In a move which appears to run counter to the government's choice agenda, the PCT has sent letters to orthopaedic patients informing them that it cannot offer patients in need of orthopaedic surgery the option of treatment at an NHS hospital. The letter warns patients that their surgery "may take place at an independent (private) hospital". It goes on: "At present we are unable to offer NHS hospitals as a choice for surgery at this point in the pathway." The local foundation trust is seeking clarification from the PCT on its processes after telling them that they did not feel patients were being offered "genuine choice". Stockport PCT chief executive Richard Popplewell said the PCT was not denying patients an NHS option. He insisted the letter had been sent to patients who had already opted to use the independent sector at the point they were referred by GPs. He said: "This is stage three or choice three of the patient pathway when the patients have already chosen to use the independent sector." After warning patients that the PCT is "unable" to offer NHS choices, the letter, penned by the PCT's senior patient choice nurse, goes on to say that patients can change their mind: "If you decide that you would prefer to be treated in totality at an NHS hospital then you need to contact me ASAP. You will then be given a choice of four or five NHS providers. We will then process your referral in the normal way to an outpatient appointment with a consultant." The foundation trust said it had not received a "satisfactory explanation" from the PCT. A spokesman said: "This letter and the PCT process seems to require patients to proactively opt out of a process that leads them into the independent sector. So far we do not feel patients are being offered a genuine choice." Foundation Trust Network director Sue Slipman expressed concern about what the letter appeared to suggest: "There was always a worry that commissioners would slow down the work going to hospitals because the contracts with the private sector are take-or-pay contracts. This is completely against patient choice." Summary by Keep our NHS Public of Health Service Journal 10 August 2006

Choice of hospital exposed as a sham. Patients are being denied treatment at their chosen hospital to ensure Government waiting targets are not breached. A Pulse inquiry has uncovered numerous examples of PCTs deleting popular hospitals from the menu of choices available to GPs using Choose and Book to ensure no patient waits longer than 13 weeks. The move has left GPs increasingly unable to book slots at patients' preferred hospital, forcing people to travel long distances to less popular clinics even when they would prefer to wait longer. The clinician in charge of Choose and Book has even revealed PCT chief executives could be at risk of the sack if they allowed patients to book slots past 13 weeks. Dr Mark Davies, clinical lead for Choose and Book at Connecting for Health, said the system allowed slots to be booked up to 180 days ahead - but commissioners had the power to take hospitals off menus if they could not offer a booking inside the 13-week target. He said: "It would be unusual for any chief executive that wants to remain in post to release slots that can be booked past 13 weeks." Areas and specialities where choice is being restricted include orthopaedics in Bristol and Exeter; ENT and cardiology in Cornwall; foot and ankle surgery in Leeds; ENT and orthopaedics in Liverpool and Swanage; and various specialities in Milton Keynes. Summary by Keep our NHS Public of Pulse 11 August 2006. [This seems to force patients to accept an offer involving long travelling even if they would prefer to wait slightly longer for the local hospital]

Minister backs benefits of choice. James Purnell, the pensions minister, has said Labour needs to embrace rather than apologise for its programme of extending competition in the public services. The former Downing Street adviser argued that figures such as Frank Dobson and Roy Hattersley believe "current public services are delivering relatively equal outcomes and that moving away from choice would reduce inequality". In the health service, he claimed that choice has helped reduce waiting lists. Summary by Keep our NHS Public of Guardian 16 August 2006

Trusts warned as 'choice of scan' takes shape. Trusts have been warned not to delay urgent diagnostic tests as part of efforts to reduce overall waiting times. The warning came in guidance on 'choice of scan': the policy to offer patients alternative providers of diagnostics in order to shorten waiting times. The guidance advises trusts on phase three of the policy, from May next year, when patients waiting for most imaging scans should be offered an alternative provider if they cannot be seen within 13 weeks. Summary by Keep our NHS Public of Health Service Journal 31 August 2006

Patients across the EU will be given the right to seek medical treatment in other countries if they face "undue delays" back home, under plans unveiled yesterday. Nicholas Watt in Brussels Wednesday September 6, 2006 The Guardian

Natural births at risk from NHS cuts. Dozens of midwife-run birthing centres could close because of NHS cuts according to the National Childbirth Trust. The organisation says that five out of 100 of the "home style" units have been shut temporarily and another 19 could be scrapped altogether. Critics have said the centres provide an "easy target" for cuts. However, recently the National Institute for Clinical Excellence raised safety concerns by reporting that babies born in the centres were twice as likely to die as in birth at a hospital due to the proximity of emergency services. Earlier this month, David Nicholson angered supporters of maternity centres by saying that women were best served by maternity units in hospitals staffed by consultants, attracting concerns from the Royal College of Midwifery. Any closures would undermine the government agenda of 'choice' and the Department of Health said that "By 2009 we expect women to have a choice about where they give birth…Decisions on reconfigurations are a local matter and will not be taken centrally." News comes as Stroud Maternity Unit received a reprieve from closure after a campaign by midwives and local residents. Summary by Keep our NHS Public of Telegraph 24 September 2006

Referral centres make lottery of GP decisions. GP referrals are increasingly being subjected to significant interference from referral management centres, a Pulse investigation has found. Evidence from almost 100 PCTs has found huge variations in the way GP referrals are being handled, with some trusts using the centres to cut up to 15 per cent of referrals. Of 93 PCTs responding to a Pulse questionnaire, 36 had a referral management system of some sort in place. Ten of the PCTs said their centre had a specific target to cut GP referrals. Orthopaedics, dermatology and physiotherapy were the disciplines where referral management was most prevalent. The most expensive centre, dealing with orthopaedics for three PCTs in the West Midlands, cost £400,000 to set up. South Leicestershire PCT reported that it was attempting to redirect 30 per cent of musculoskeletal referrals away from acute hospitals. East Elmbridge and Mid Surrey PCT had a target to cut 15 per cent of all referrals. GPs in the areas where the most intrusive centres were in place reported they were holding back referrals, interfering with patient choice and increasing their workload. Summary by Keep our NHS Public of Pulse 6 October 2006

Referrals 'put in cupboard'. A referral management centre in Milton Keynes physically locked GPs' letters in a metal cupboard for weeks to deliberately delay patients' treatment. Dr Peter Berkin, a GP and professional executive committee member at Milton Keynes PCT, said the routine referral letters were stored in the cupboard to stop local hospitals doing too many procedures too quickly and overspending. He said the practice was 'a tragedy waiting to happen'. 'Several of us on several occasions have sat and trawled through all the letters looking for dodgy ones,' he said. 'There could be cancer patients sitting in there.' Summary by Keep our NHS Public of Pulse 6 October 2006

How referral management is working. South Leicestershire PCT:
o Musculoskeletal service
o GPSI, extended scope physios and podiatrist
o Set-up cost £2,000 a year
o Cost £100,000 a year but also treats patients
o 30 per cent of referrals redirected
o Net savings £50,000 a year

East Elmbridge & Mid Surrey PCT:
o Triages referrals - sent to GPSI/ acute provider/ returned to GP as unnecessary/ inappropriate
o Handled 68,000 in total
o 40 per cent redirected
o 10 per cent returned to GP

North and East Birmingham PCT:
o Managed by GPs via peer review process similar to prescribing
o Set-up cost £2,000
o 14 per cent cut in referrals; total savings of £400,000 produced

Trafford North and South PCT:
o Forwards paper referrals, does not redirect
o Set up cost £148,000
o Handles 57,000 referrals for ENT, orthopaedics, musculoskeletal and cardiology Cardiff Local Health Board
o All dermatology referrals logged and recorded before being passed on to the relevant provider
o Running cost just over £37,000 a year
o Handles 10,000 referrals a year

Wednesbury and West Bromwich, Oldbury and Smethwick, Rowley Regis and Tipton PCTs:
o Orthopaedics only
o Set-up cost £400,000
o Set up in 2005
Summary by Keep our NHS Public of Pulse 6 October 2006

NHS hospitals are preparing to embark on an advertising war to attract more patients in response to the government's decision to give people more choice about where they go for treatment, the Guardian has learned. The move follows publication today of the first advertisement by an independent hospital chain to woo NHS patients by explaining the opportunities it can offer for free treatment in the private sector, paid for by the taxpayer. Capio Healthcare, a Swedish company with more than 30 hospitals and treatment centres in England, aimed its first ads at GPs and other health professionals to persuade them to help patients "make the right choices about where they receive their care". Tom Mann, the chief executive, said this would be followed by direct advertising to patients. John Carvel, social affairs editor Thursday October 19, 2006 The Guardian

Thousands of patients are being denied access to hospital consultants because the NHS has set up money-saving management schemes which block GPs' referrals. In direct contradiction to the government's claims to be encouraging more choice in healthcare, patients with