Socialism and Health The journal of the Socialist Health Association
Autumn 2004
2/2004
SLOGAN OF CHOICE “Choice” for patients is the new buzzword, the slogan around which the Labour and Conservative parties will joust on the health battlefield in the forthcoming General Election. Strategists for both parties claim that “choice” in health care is what the public wants.
groups – “pro-active” choice that better off from the taxes that everyone invests time and effort in explaining pays for the NHS. options and helping people to make decisions. Patient choice is intended It is, however, also difficult to accept also as the stimulus that will ensure Labour’s argument that choice is that providers put a proper emphasis intrinsic to equity. On the contrary, on the needs and preferences of users. more patient choice may mean less At the same time it will reduce the equity. likelihood that better off people will opt out of the NHS and then question Some people are more able to take why they should be taxed to pay for advantage of choice than others. The the NHS. middle classes, for example, may turn
Labour’s intention is to introduce “choice” within a programme of expanding NHS capacity that provides a greater range of health to the independent sector if a waiting care options for patients. Labour The Tories plan to give every patient list is too long. They are not limited argues that this will be the first time the right to treatment at any NHS by the resource limitations of the in the context of health care that hospital in the country. This choice NHS. The choice now being promoted everyone will have the ability to will be “unrestricted and immediate”.by our government is a well-meaning choose. A start is already being made Alternatively, every patient will have attempt to build more equity into this for those who have been on a waiting the right to treatment at any system so that poorer people are also list for more than 6 months - they now independent hospital that can treatnot limited by NHS resource have “choice”. patients at the standard NHS tariff. constraints. So to an extent choice = increased capacity. The intention is that universal choice But then comes the fundamental will give poorer people some of the inequity. Any patient who chooses an This is achieved in a number of ways, same options presently available only independent or private hospital that including care in the private sector to the middle classes. It will redress charges more than the standard NHS that is paid for by the NHS, importing the current imbalance whereby only tariff will be given half that NHS tariff teams of foreign practitioners to the wealthy can choose to avoid to spend on their treatment – thus undertake specific procedures – such under-performing providers. To do reducing the amount they, or their as cataract operations, sending this, special effort will go in to insurers, pay. This is of course just patients abroad to be treated and designing choice mechanisms so that queue jumping in a new guise, a bringing new facilities into the NHS. they can be used by socially excluded subsidy for private care payable to the One such example was the purchase