Devolution and Patient Choice: Policy Rhetoric versus
Experience in Practice
Stephen Peckham, Nicholas Mays, David Hughes,
Marie Sanderson, Pauline Allen, Lindsay Prior, Vikki
Entwistle, Andrew Thompson and Huw Davies
Abstract
Background: market reforms in England have been identified as making a clear distinction between
English health policy and health policy in the devolved systems in Northern Ireland, Scotland and
Wales. Patient choice is a high profile policy in the English National Health Service that constitutes
significant changes to the demand side of health care. It is not clear what national differences this
has led to regarding implementation of policy. This article presents the findings from a large
UK-wide study on the development and implementation of policies related to patient choice of
provider. The findings reported here relate specifically to the policy development and organizational
implementation of choice in order to examine the impact of devolution on health care policy.
Aim: this study examines patient choice of provider across all four countries of the UK to understand
the effect of differences in national policies on the organization and service how choice of provider
presented to patients.
Methods: at the macro-level, we interviewed policymakers and examined policy and guidance
documents to analyze the provenance and determinants of national policy in each UK nation. At the
Primary Care Trust or Health Board level, we interviewed a range of public and private health
service providers to identify the range of referral pathways and where and when choices might be
made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how
such choices were experienced.
Findings: while we found that distinct rhetorical differences were identifiable at a national policy
level, these were less visible at the level of service organization and the way choices were provided
to patients.
Conclusion: historical similarities in both the structure and operation of health care, coupled with
common operational objectives around efficient resource use and waiting times, mediate how strategic
policy is implemented and experienced in the devolved nations of the UK.
Address for correspondence: Stephen Peckham, Department of Health Services Research and Policy,
London School of Hygiene and Tropical Medicine, London WCH SH, England. Email: stephen.peckham@
lshtm.ac.uk
S P &A 0144–5596
DOI: 10.1111/j.1467-9515.2011.00831.x
V. 46, N. 2, A 2012, . 199–218
© Blackwell Publishing Ltd., Garsington Road, Oxford OXDQ , UK and
Main Street, Malden, MA , USA