/ Health, Parenting

Do you want more choice in public services?

Choice written on blackboard

From hospitals to schools and social care, an independent review by David Boyle concludes we want more choices in public services. David Boyle explains why the UK should move towards a broader kind of choice.

Last year, I was asked by the government to look at choice in public services, and what gets in the way of people making choices.

The chance to choose what hospital we go to, or what school we send our children to and how we use our money for social care… This has all developed over the past ten years with backing from this government and the last.

In the opinion poll we commissioned, 81% said they thought it’s important to have a choice of service. Clearly, people are keen to get a choice, especially when things have gone wrong in the past with the way they were treated. The difficulty is that there has been very little research about whether people were actually using those choices, whether it was difficult for them to do so and what got in the way.

Barriers to choice in public services

For my ‘The Barriers to Choice Review’, I spoke to people the length and breadth of Britain. Although it was clear that people from all backgrounds want a choice in the services they receive – they want a meaningful choice. They want all the information and the advice they need, and the confidence and authority to ask for flexibility in the way services are delivered.

Often the kind of choices we think we’re being offered are not what we’re actually getting.

We may get to choose where an out-patient’s appointment is going to be, or express a preference about where your children should go to school. But my work showed that people want something less neat, and sometimes simpler – like a choice of a consultant who won’t mind you asking them lots of questions. Or to study Spanish at A-level when all that prevents you is the school’s timetabling system. Or to go to bed later than 5 o’clock when your carer comes round.

Unless you’re confident and articulate, bureaucratic barriers can get in the way of making these choices. And if you want something slightly out of the mainstream then there’s inequality in the choices available to everyday people across the UK, because you need confidence to overcome them.

Plus, we all need information and advice on what choices are available to us, yet this often proves problematic. Not everyone has access to the internet and this makes it even harder to find out what choices are available. Others would prefer face-to-face advice.

Giving you more authority

I hope my report helps officials understand that people with the same symptoms or situation might actually want different treatment. People should be given more authority, at least to ask if their specific needs can be accommodated.

We live in a post-assembly line world: not everyone needs to be treated in exactly the same way, just as everyone’s priorities are different. But choice also needs to recognise that we are not just passive recipients of public services. Real choice means we can begin to share responsibility with professionals, for our own care and recovery – and maybe also for the recovery of those around us.

Do my findings fit with your experiences of making choices in public services? Would you like a broader kind of choice?

Which? Conversation provides guest spots to external contributors. This is from David Boyle, the independent reviewer of the government’s Barriers to Choice Review. All opinions expressed here are David’s own, not necessarily those of Which?


There is no question that many want some input into the choice of service provider whether health, education or whatever. However this is only sensible if real information on the quality of the institution or individual involved is readily available in an understandable form.

Quality vs convenience will depend on the service – for healthcare quality is the priority, whilst for education convenience is high on the list as it is a long-term choice.

The stability of the service offered is important – we have too many organisational changes that get in the way of real quality improvement – there seems to be a lack of faith in those who operate the service to have the commitment to improve it, so we have “targets” and “key performance indicators” that may have dubious connection with real life but seem to absolve the management from real responsibility for service improvements. I’m a great believer in letting the workers in the service – doctors, teachers for example – play a major part in operating the service, not professional managers who seem not to grasp the nuts and bolts issues.

Finally, the comment is often made in these converstions that those without inernet access find it harder to get the information necessary to make choices. This is a negative attitude – whilst we should help those get better access to information, I prefer to see it as a benefit to those who have internet access without detriment to those who don’t. It is progress.

Julia Clark says:
1 February 2013

A lot of the “choices” we are offered are bogus. If there is only one hospital within reasonable travelling distance the choice of another hospital 2 hours away is not viable. Even with the closest A&E I would be stuck without a car. The choice I would really like is to go to the smaller local “hospital” where you don’t get stuck in a cubicle and ignored and are less likely to get MRSA. Then if you need someone to come and get you that is much easier. Would it not be possible for a handful of medical staff to travel within a region rather than hundreds of patients.

It often seems as though decision makers forget that we don’t all live in London.

The greatest possible choice is when you have the cash in your pocket to buy the service you want, at the time and location you prefer.
I worked in the NHS previously, a conveyer belt system! The more people use the service, the faster you have to run belt, the less quality and choice you are able to offer.

Working in the private sector now, we have the time, space and choice of intervention, but not enough users to make the service sustainable in the long term. Cannot compete with a service given for free.

Wish patients are given a choice where they want to spend their health money!

The NHS is not free for many – we pay for it through NI and taxes. my experience of it is good – not a conveyor belt but interested professionals trying to help, rather than make a profit. There are occasions I must admit when you need to be firm in pushing your needs, but maybe that is not a bad thing. Perhaps I am an exception in having this view?

In the past thirty two years I have been registered with four GP surgeries and the difference has been unbelievable. The best was a one-man practice that was closed down by the Primary Care Trust, despite the formation of a group of mainly academics and students to protest against its closure. It’s the only protest group I’ve been a member of – and we failed. At least our GP got to know how well he was valued. The worst GP gave advice that is well known to be dangerous for an asthmatic and failed to complete a yellow form to notify a suspected adverse drug reaction that I experienced. My current GP practice does a very efficient job. Anyone who has a choice of local GP practices should speak to users. My own experience has been very similar to that of other patients.

I have seen both excellent, mediocre and abysmal treatment of myself, family and friends in NHS hospitals. I’m not sure that choice is nearly important as having visitors to keep an eye on how patients are being cared for.