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Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Stephen Peckham, Nicholas Mays, David Hughes, Marie Sanderson, Pauline Allen, Lindsay Prior, Vikki Entwistle, Andrew Thompson, Huw Davies

Social Policy & Administration, Volume: 46, Issue: 2, Start page: 199

Swansea University Author: David Hughes

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DOI (Published version): 10.1111/j.1467-9515.2011.00831.x

Abstract

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes si...

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Published in: Social Policy & Administration
ISSN: 0144-5596
Published: Wiley Blackwell 2012
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URI: https://cronfa.swan.ac.uk/Record/cronfa10679
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spelling 2011-10-01T00:00:00.0000000 v2 10679 2012-04-20 Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice f1fbd458e3c75d8b597c0ac8036f2b88 David Hughes David Hughes true false 2012-04-20 Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK-wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy.Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients.Methods: at the macro-level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced.Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients.Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK Journal Article Social Policy & Administration 46 2 199 Wiley Blackwell 0144-5596 Patient choice, devolution, health policy 31 12 2012 2012-12-31 10.1111/j.1467-9515.2011.00831.x COLLEGE NANME COLLEGE CODE Swansea University 2011-10-01T00:00:00.0000000 2012-04-20T07:48:15.4075464 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health Stephen Peckham 1 Nicholas Mays 2 David Hughes 3 Marie Sanderson 4 Pauline Allen 5 Lindsay Prior 6 Vikki Entwistle 7 Andrew Thompson 8 Huw Davies 9
title Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice
spellingShingle Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice
David Hughes
title_short Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice
title_full Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice
title_fullStr Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice
title_full_unstemmed Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice
title_sort Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice
author_id_str_mv f1fbd458e3c75d8b597c0ac8036f2b88
author_id_fullname_str_mv f1fbd458e3c75d8b597c0ac8036f2b88_***_David Hughes
author David Hughes
author2 Stephen Peckham
Nicholas Mays
David Hughes
Marie Sanderson
Pauline Allen
Lindsay Prior
Vikki Entwistle
Andrew Thompson
Huw Davies
format Journal article
container_title Social Policy & Administration
container_volume 46
container_issue 2
container_start_page 199
publishDate 2012
institution Swansea University
issn 0144-5596
doi_str_mv 10.1111/j.1467-9515.2011.00831.x
publisher Wiley Blackwell
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
document_store_str 0
active_str 0
description Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK-wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy.Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients.Methods: at the macro-level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced.Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients.Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK
published_date 2012-12-31T12:22:10Z
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score 11.048237

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