More Patient Choice in England's National Health Service

2005 ◽  
Vol 35 (3) ◽  
pp. 479-483 ◽  
Author(s):  
Richard Lewis
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Urban Areas ◽  
Patient Choice ◽  
Private Provider ◽  
National Quality ◽  
The Government ◽  
English National Health

A new political consensus has emerged over the benefits of new rights for patients to choose their provider of elective health care in the English National Health Service. From December 2005, patients will be able to select from a number of alternative providers at the time they are referred for treatment. In the longer term, patients will be able to access care at any public or private provider that meets national quality and cost standards. The government intends that this policy will lead to improvements in the quality and efficiency of health care and will reduce levels of inequity among patients. Pilot schemes have shown that a majority of patients will exercise a choice of provider when this is offered. However, the policy of patient choice may involve significant costs to the NHS and may be more difficult to implement outside urban areas. Further, the information needed to support patients' choices is not yet available. Whether such a policy will increase or decrease levels of equity in the English NHS remains open to debate.

scholarly journals “With Great Power Comes Great Responsibility”: Democracy, the Secretary of State for Health and Blame Shifting Within the English National Health Service

2018 ◽  
Vol 48 (3) ◽  
pp. 461-481 ◽  
Author(s):  
David I Benbow
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
Social Relations ◽  
National Health ◽  
Market Reforms ◽  
Democratic Deficit ◽  
The Government ◽  
English National Health ◽  
English National Health Service

The English National Health Service (NHS) has suffered from a democratic deficit since its inception. Democratic accountability was to be through ministers to Parliament, but ministerial control over and responsibility for the NHS were regarded as myths. Reorganizations and management and market reforms, in the neoliberal era, have centralized power within the NHS. However, successive governments have sought to reduce their responsibility for health care through institutional depoliticization, to shift blame, facilitated through legal changes. New Labour’s creation of the National Institute for Clinical Excellence (NICE) and Monitor were somewhat successful in reducing ministerial culpability regarding health technology regulation and foundation trusts, respectively. The Conservative-Liberal Democrat coalition created NHS England to reduce ministerial culpability for health care more generally. This is pertinent as the NHS is currently being undermined by inadequate funding and privatization. However, the public has not shifted from blaming the government to blaming NHS England. This indicates limits to the capacity of law to legitimize changes to social relations. While market reforms were justified on the basis of empowering patients, I argue that addressing the democratic deficit is a preferable means of achieving this goal.

Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?

2010 ◽  
Vol 5 (3) ◽  
pp. 343-363 ◽  
Author(s):  
Gwyn Bevan ◽  
Wynand P. M. M. van de Ven
Keyword(s):  
National Health Service ◽  
Health Service ◽  
The Netherlands ◽  
National Health ◽  
Thought Experiment ◽  
Internal Market ◽  
Patient Choice ◽  
Market Model ◽  
English National Health ◽  
English National Health Service

AbstractIn the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.

scholarly journals Patient choice in forensic settings: managing requests for change of consultant

2007 ◽  
Vol 31 (12) ◽  
pp. 443-446 ◽  
Author(s):  
Caroline Jacob ◽  
Eluned Dorkins ◽  
Helen Smith
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Patient Choice ◽  
Department Of Health ◽  
The Government

The National Health Service (NHS) is undergoing extensive modernisation. Central to this process is the move away from a professional-led health service to a patient-centred system, which offers patients the ‘power’ to make decisions about their healthcare. In 2003, the government announced their plans for ‘patient choice’ within the NHS (Department of Health, 2003).

scholarly journals Doing More with Less in Health Care: Findings from a Multi-Method Study of Decommissioning in the English National Health Service

2017 ◽  
Vol 47 (3) ◽  
pp. 543-564 ◽  
Author(s):  
JENNY HARLOCK ◽  
IESTYN WILLIAMS ◽  
GLENN ROBERT ◽  
KELLY HALL ◽  
RUSSELL MANNION ◽  
...  
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Online Survey ◽  
Local Context ◽  
National Study ◽  
Local Health ◽  
English National Health ◽  
English National Health Service

AbstractIn the context of an austere financial climate, local health care budget holders are increasingly expected to make and enact decisions to decommission (reduce or stop providing) services. However, little is currently known about the experiences of those seeking to decommission. This paper presents the first national study of decommissioning in the English National Health Service drawing on multiple methods, including: an interview-based review of the contemporary policy landscape of health care decommissioning; a national online survey of commissioners of health care services responsible for managing and enacting budget allocation decisions locally; and illustrative vignettes provided by those who have led decommissioning activities. Findings are presented and discussed in relation to four themes: national-local relationships; organisational capacity and resources for decommissioning; the extent and nature of decommissioning; and intended outcomes of decommissioning. Whilst it is unlikely that local commissioners will be able to ‘successfully’ implement decommissioning decisions unless aspects of engagement, local context and outcomes are addressed, it remains unclear what ‘success’ looks like in terms of a decommissioning process.

scholarly journals The Value of Data: Applying a Public Value Model to the English National Health Service

10.2196/15816 ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. e15816
Author(s):  
James Wilson ◽  
Daniel Herron ◽  
Parashkev Nachev ◽  
Nick McNally ◽  
Bryan Williams ◽  
...  
Keyword(s):  
Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Health Care Systems ◽  
Value Theory ◽  
Health Data ◽  
Public Value ◽  
English National Health ◽  
English National Health Service

Research and innovation in biomedicine and health care increasingly depend on electronic data. The emergence of data-driven technologies and associated digital transformations has focused attention on the value of such data. Despite the broad consensus of the value of health data, there is less consensus on the basis for that value; thus, the nature and extent of health data value remain unclear. Much of the existing literature presupposes that the value of data is to be understood primarily in financial terms, and assumes that a single financial value can be assigned. We here argue that the value of a dataset is instead relational; that is, the value depends on who wants to use it and for what purposes. Moreover, data are valued for both nonfinancial and financial reasons. Thus, it may be more accurate to discuss the values (plural) of a dataset rather than the singular value. This plurality of values opens up an important set of questions about how health data should be valued for the purposes of public policy. We argue that public value models provide a useful approach in this regard. According to public value theory, public value is created, or captured, to the extent that public sector institutions further their democratically established goals, and their impact on improving the lives of citizens. This article outlines how adopting such an approach might be operationalized within existing health care systems such as the English National Health Service, with particular focus on actionable conclusions.

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