Giving people a choice of hospitals for their treatment is valued by most patients but the system is not yet operating as it was meant to. That’s the conclusion of a report today which says it has not so far acted as a lever to improve quality and increase competition.

It is two years since patients in England were given the chance to choose treatment from any hospital in a national directory. The new report ‘Patient Choice: How patients choose and how providers respond’, published by the King’s Fund with the Picker Institute, RAND Europe and the Office of Health Economics looked at how choice is operating and was based on research with patients, GPs and hospital providers.

Researchers found three quarters of patients wanted a choice over where they were treated but only around half remembered being offered a choice by their GPs. Of those who did get a choice only 8 per cent were offered the option of choosing a private provider. Just over two thirds remained loyal to their local hospital and chose to be treated there. Bad experiences at local hospitals were a major reason for opting to go elsewhere but very few patients made use of performance data to inform their choices. Only 4 per cent consulted the NHS Choices website. GPs broadly welcomed choice but strongly criticised the Choose and Book system, which they found difficult to use in spite of technical improvements.

The report says while there were no apparent inequities among those being offered a choice, it was older, more educated patients who were more likely to choose a non-local provider. That, it suggests, poses a risk that where local services are poor some patients may be ‘left behind’ while others exercise their right to be treated elsewhere.