Choosing Voices: The Department of Health's online interpretation of what patients want

Abstract

Since 2005, reforms in the National Health Service in England, overseen by the British government's Department of Health (DH), have further stimulated a market by increasing the number of providers and encouraging patient choice. This study compares the DH's reporting until 2010, on its website, of ‘what patients want’ and the research evidence for its statements. It will consider whether the evidence is more ambiguous than the website summary implied; obscuring the voices of those with opinions running counter to patient choice, as the DH defined it. Finally, it reflects on whether there has been a subsequent change of approach.

Key words:

• NHS
• Department of Health
• online political communications
• choice
• public opinion

Acknowledgements

The authors would like to thank Professor Jane Broadbent, Nicholas Jones and the three anonymous reviewers for their very helpful comments and suggestions on drafts of this paper.

Notes

Proposed changes will distance the DH from the service by creating an intermediate NHS Commissioning Board (DH, 2010a: 5).

This is not least because it was part of a ‘meticulously coordinated’ promotional offensive conducted on both sides of the Atlantic (Stanyer, 2007: 67).

The webpage text falls within the scope of the Civil Service Code, not least because relevant academic and political debate has recorded public controversy on this issue (for instance, Anon, 2005; Edwards, 2010; Greener and Powell, 2009; Le Grand, 2003; Pollock, 2004). If the information had been written to the Information Standard (DH, 2009b) then it can be argued that references would have been required.

DH, 2006a was concerned with services in Northern Ireland and was thus excluded from the analysis.

This major public consultation was conducted by pollsters close to the Labour government (Mattinson, 2010). It questioned nearly 43,000 people, cost approximately £1 million to produce and, Hewitt reports, formed the basis for the White Paper, Our Health, Our Care, Our Say. It culminated in an approximately 1000-strong Citizens' Summit in Birmingham (DH, 2007b; Hewitt, 2010; OLR, 2006).

When the later British social attitudes research considered whether enthusiasm for choice over NHS-funded care extended to support for diversity of provider type, the public was overwhelming opposed to private companies running or providing NHS hospitals, while also rejecting charities running hospitals, albeit by a slim margin. The British Social Attitudes data show ‘it is very clear that the public's support for choice is not necessarily accompanied by enthusiasm for a diversity of providers’ (Curtice and Heath, 2009: 67, 69).

Such gains are terms for improvements in productivity caused by competition.

Greater Choice and Control cites a recent review of patient choice by Dixon et al. but this itself fails to reference the 2009 British Social Attitude Survey findings of Curtis and Heath (Curtice and Heath, 2009; DH, 2010b: 4, 25, 32; Dixon et al., 2010).