The destabilising effects of patient choice: law, policy, politics and the paradox of complementary alternative medicine in the NHS

Abstract

Despite the unproven effectiveness of many practices under the umbrella term ‘complementary alternative medicine’ (CAM) there is considerable public demand for, but only limited provision of, CAM within the English National Health Service (NHS). This thesis examines whether government support for patient treatment choice creates a bigger space for CAM within the NHS. It argues that policy-makers use choice both as policy initiative and as rhetorical device where the reference to choice ranges from liberal choice to consumer choice. At the same time treatment choice and personalised healthcare are politically justified by relying on the traditional NHS values of equity and universality and on the notion of patient responsibilisation. The different meanings claimed for choice in the political domain are mirrored by the perceptions of patient choice in tort law and in public law (including its European Union dimension). However, the legal analysis shows that English domestic law will not generally uphold the NHS patient’s claim to a specific treatment. The thesis suggests that private and public law litigation by patients to enforce their demands against a doctor or health authority not only functions as a dispute resolution mechanism but also exerts unsettling effects on healthcare institutions and practices. Although these effects are unlikely to be intended by the litigants they in turn support policy-makers’ use of choice as a lever for change and reform. The thesis concludes that the government patient choice policy ought to be viewed as a strategy to destabilise and to encourage change within the NHS and its entrenched institutions and may have the unintended consequence of the emergence of a greater role for CAM. This finding coincides with the theme in government healthcare policy of patient responsibilisation also promoted by CAM’s emphasis on self-care and self-management.