An introduction to patient choice

In the NHS, patients can make choices about their healthcare. It has been argued that patient choice may provide incentives for providers to improve so they can attract patients. Additionally, patient choice has been seen as a way of ensuring that it is not just those who know how to navigate the system that can make choices about how and where they are treated. 

Patient choice has been around for many years. This is a brief history of patient choice in the NHS over the past 20 years.   

It was in the early 2000s that the NHS first developed policies so that patients would have more choices about their care. The NHS set a target that by December 2005 all patients would have a choice of four or five different providers for their treatment after being referred by their GP.  

NHS Constitution – right to choose  

Patient choice policies became patient choice rights in 2009 with the introduction of the NHS Constitution. In it, patients are guaranteed the right to make choices about their care.  

“You have the right to make choices about the services commissioned by NHS bodies and to information to support these choices.” 

NHS Choice Framework  

NHS Constitution rights to choose are set out in the NHS Choice Framework which has been updated periodically – most recently in 2020. The NHS Choice Framework sets out what rights patients have to choose. These include a range of different rights and information about how the NHS must ensure that patients can exercise their choices.  

The NHS Choice Framework provides patients with a legal right to choose their provider at the point of referral:  

You can: 

• decide which NHS organisation you would like to receive care from as an outpatient 
• choose the clinical team who will be in charge of your care within an organisation 

Under the NHS Choice Framework patients can choose to have their treatment “in any hospital appointed by the NHS to provide this service: including some private hospitals at no greater cost to the NHS.” 

Choice at 18 weeks 

The NHS Choice Framework also gives patients a right to ask to change hospital if they have to wait longer than the maximum waiting times. 

You can ask to be referred to a different hospital if: 

• you have to wait more than 18 weeks before starting treatment for a physical or mental health condition, if your treatment is not urgent 
• you have to wait more than 2 weeks before seeing a specialist for suspected cancer 

Waiting times can vary between hospitals and you have the right to be referred to another hospital that may be able to start your treatment sooner. 

In reality, few patients have ever exercised that right and it is not widely known. 

Choice at 26 weeks – 2019 

With waiting times rising, the NHS Long-Term Plan of 2019 developed a policy to offer patients a choice of alternative provider once they had been waiting 26 weeks. Pilot programmes were run in some areas with high levels of uptake when patients were offered faster treatment at an alternative provider.  

The NHS Long-Term Plan set out the intention “to implement a planned NHS-managed choice process across the country for all patients who reach a 26-week wait” (2.38). For the first time this was to be a proactive offer of choice by the NHS system – not a right that patients could exercise if they chose.  

This intention was then included in the 2020/21 NHS Operational Guidance: 

“During 2020/21, all providers and systems should be implementing supplementary choice at 26 weeks” (page 13) 

However the impact of Covid-19 then meant that choice at 26 weeks was never widely adopted, and the current backlog position makes it all the more important that a fresh look is taken at patient choice.