Cooper et al are to be congratulated on addressing the important
issue of the impact of recent NHS reforms on equity. In order to
investigate this they determined the changes in waiting times occurring
for certain key elective surgical procedures and the distribution of these
changes in different socioeconomic groups [1]. They conclude that the
later stages of NHS reforms, including patient choice, provider
competition and expanded capacity, did not harm equity. This is arguably
misleading.
Concerns about inequity arising from patient choice may not be
manifested in waiting times for elective surgery. Firstly, the authors
concede that measures to drive down waiting times for elective treatment
have become increasingly stringent over the time analysed, due to distinct
policy changes from the above reforms [2]. Waiting times will therefore be
an insensitive method to detect inequity resulting from NHS reforms as
hospitals attempt to meet shorter waiting time targets. It is unsurprising
that inequity falls in such a scenario but little inference should be made
of the impact of more distantly related policies.
Secondly, it can be argued that patients in higher socioeconomic
groups are more likely to exercise their right to choose where to receive
treatment [3]. However, such choice may not result in merely choosing the
shortest waiting time but might instead lead to choosing health care
providers that are perceived to excel. The hospitals providing such
elective surgery may even have longer waiting times. What is needed is a
consideration of recent NHS reforms on the equity of quality of care
outcomes rather than waiting times.
The implications of "Choose and Book" and other recent reforms will
be far reaching for the English NHS and much more evidence is needed to
form an adequate assessment of their impact on equity.
1. Cooper, Z.N., et al., Equity, waiting times, and NHS reforms:
retrospective study. BMJ, 2009. 339: p. b3264.
2. The Kings Fund, Cutting NHS Waiting Times: Identifying Strategies for
Sustainable Reductions. February 2005: London.
3. The Kings Fund, What is the Real Cost of More Patient Choice? 2003:
London.
Rapid Response:
Waiting Times Are a Poor Marker For Equity
Cooper et al are to be congratulated on addressing the important
issue of the impact of recent NHS reforms on equity. In order to
investigate this they determined the changes in waiting times occurring
for certain key elective surgical procedures and the distribution of these
changes in different socioeconomic groups [1]. They conclude that the
later stages of NHS reforms, including patient choice, provider
competition and expanded capacity, did not harm equity. This is arguably
misleading.
Concerns about inequity arising from patient choice may not be
manifested in waiting times for elective surgery. Firstly, the authors
concede that measures to drive down waiting times for elective treatment
have become increasingly stringent over the time analysed, due to distinct
policy changes from the above reforms [2]. Waiting times will therefore be
an insensitive method to detect inequity resulting from NHS reforms as
hospitals attempt to meet shorter waiting time targets. It is unsurprising
that inequity falls in such a scenario but little inference should be made
of the impact of more distantly related policies.
Secondly, it can be argued that patients in higher socioeconomic
groups are more likely to exercise their right to choose where to receive
treatment [3]. However, such choice may not result in merely choosing the
shortest waiting time but might instead lead to choosing health care
providers that are perceived to excel. The hospitals providing such
elective surgery may even have longer waiting times. What is needed is a
consideration of recent NHS reforms on the equity of quality of care
outcomes rather than waiting times.
The implications of "Choose and Book" and other recent reforms will
be far reaching for the English NHS and much more evidence is needed to
form an adequate assessment of their impact on equity.
1. Cooper, Z.N., et al., Equity, waiting times, and NHS reforms:
retrospective study. BMJ, 2009. 339: p. b3264.
2. The Kings Fund, Cutting NHS Waiting Times: Identifying Strategies for
Sustainable Reductions. February 2005: London.
3. The Kings Fund, What is the Real Cost of More Patient Choice? 2003:
London.
Competing interests:
None declared
Competing interests: No competing interests