The NHS at 70 – with patient choice at its heart

This week sees the 70th anniversary of the start of the NHS, and from the very get-go patient choice has been at its heart.

At the time the NHS represented a revolution in the availability and delivery of health care, not least that for the first time it provided care free of charge to everyone, regardless of wealth. Several generations of UK citizens have benefitted from this, and the fact that NHS services are free to all at the point of delivery is universally known.

What is not quite so well known or understood are our rights under the NHS Constitution to choose where we receive our treatment. In 1948 when the NHS was founded, choice was an important element of its innovation – for the first time people were able to choose their GP, optician and dentist. Patients were still required to access services local to them.

The notion of patient choice was expanded in 1972 when the NHS was reorganised to be more responsive to the needs and choices of patients. People who used NHS services were to be considered as consumers. There was now an element of choice in the treatment patients received, and it allowed people to seek private treatment.

In 1989 the NHS changed to provide services more appropriate to individual patients, and a system was introduced whereby patients were given more information to be able to make a choice between GPs. By 2000 patients were able to choose the date and time of their hospital appointment, and two years later pilots began for Patient Choice.

Other changes followed under Tony Blair’s Labour Government. In 2003 the white paper “Building the Best: Choice, Responsiveness and Equity in the NHS” created more opportunities for choice and for patients to become more involved in their treatment.

By 2006 our right to choose had been extended to a choice between four or five hospitals, and it was at this point that treatment centres such as ours were created to provide patients with more choice for elective (planned) surgery. We welcomed our first patients in April 2005.

By 2008 a new electronic system, ‘choose and book’, had been introduced to allow patients to make their own appointments online or by phone. Registering for the GP of your choice became easier and those with a long-term condition were entitled to a care plan. The NHS Choices website was launched and the original hospital choice scheme introduced in 2006 was replaced in 2008 by the right to choose to have treatment in any facility which offers NHS care. We have certainly seen a growing number of people using this right – in the past year, for example, 1500 NHS patients from Cornwall have travelled over 50 miles to Plymouth for their care, almost half of them for major orthopaedic surgery.

Embedded within these changes was another right – if you have been told you must wait for longer than 18 weeks for treatment, you can ask to be moved to a shorter waiting list at another care provider.

This right has not been widely publicised, but it is a valuable one for patients and means they do not have to wait for treatment for longer than is necessary – often while in intolerable pain.

There is capacity within the system for patients to switch waiting lists – indeed, we are seeing a greater number of patients who have decided to leave a long list and come to us for their care. One example is Leslie Mayne from North Devon who, after being told his wait for a new hip had been extended to 62 weeks, did some research and visited Pensisula NHS Treatment Centre for treatment. He commented: “If I had known about Peninsula NHS Treatment Centre in May of last year I could have saved myself months of unnecessary waiting.

As the NHS celebrates its 70th anniversary, it is reassuring to know that patient choice remains central to its philosophy and delivery. Choice is not only good for us as patients, but it is also of benefit to the NHS itself as choice helps us to make the best use of the resources the NHS has available.

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