Choice and equity: lessons from long term care

On the face of it, recent statements about the equation of choice with equity in the NHS and social care seem to strengthen the government's commitment to care services that are both fair and responsive. Few would oppose increased choice for consumers of public services as a general principle. The United Kingdom, when judged overall, has long had one of the most equitable healthcare systems among developed countries. Inequalities in healthcare provision and the health status of the population have, however, always been marked, and improvement in equity has always been an important policy objective. The government is now arguing that patients should be given more choice about how their own health care is managed and that this managed choice will help to drive up quality in the new, fixed price, internal market. This idea may have some attractions for patients who are unhappy with aspects of their treatment and care, but we do know how far choice will be realised in practice. Lessons from recent history show that more educated, higher socioeconomic groups tend to take advantage, patients outside metropolitan areas find it hard to "shop around" owing to lack of choice of hospitals, and in general patients are unwilling to travel far anyway.