Research report
19 Nov 2012

This report by the Institute for Fiscal Studies (IFS), commissioned by the Nuffield Trust, examines the effect of patient choice and the independent sector on treatment location in England.


Key slides showing the impact of increased patient choice on use of independent sector treatment centres.

Over the past 10 years, governments have sought to increase patient choice and promote competition for clinical care among providers within the English National Health Service (NHS).

Patients have been affected most directly by two policies: first, the reforms in 2006 and 2008, which offered patients a choice over where they attended a first outpatient appointment; second, since 2007, the expansion in the number and capacity of Independent Sector Treatment Centres (ISTCs), which are privately owned but treat NHS-funded patients.

The use of private providers to treat NHS patients is no longer a marginal policy reform and deserves greater investigationElaine Kelly, Institute for Fiscal Studies, report co-author

Choosing the place of care: The effect of patient choice on treatment location in England, 2003 – 2011, produced jointly by the Nuffield Trust and Institute for Fiscal Studies (IFS), examines the extent to which patients (or their referring doctors) have been choosing a different location of care since 2006.

Although previous studies looking at ISTCs have looked at quality and waiting times, this is the first to examine the effect on treatment location.

Among the report’s findings are that although in 2010 the majority of patients still received outpatient care from their nearest NHS trust, and the volume of patients seen at the nearest trust increased from 2006/7 to 2010, there was a decrease in the proportion of patients attending their nearest NHS trust and an increase in those attending ISTCs.

This report is the first output from a three-year joint programme of work between the IFS and the Nuffield Trust: Understanding competition and choice in the NHS, which will establish a long-term expertise in the use of competition and market mechanisms in health care in England and internationally.

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