1. Understanding competition and choice in the NHS
Evaluating the impact of patient choice on
place of care
Elaine Kelly and Gemma Tetlow
November 2012 © Institute for Fiscal Studies and Nuffield Trust, 2012

2. Choosing the place of care
• The Health and Social Care Act paves way for more competition
and market mechanisms
• Understanding Competition and Choice in the NHS: three-year
joint Nuffield Trust/IFS research programme
• Choosing the Place of Care is first output from the programme
• Examines the effect of patient choice and Independent Sector
Treatment Centres (ISTCs) on treatment location in England,
2003–2011
© Institute for Fiscal Studies and Nuffield Trust, 2012

3. Distribution of selected elective procedures
across provider types by year, 2003/04 to 2010/11

4. Change in the percentage admitted to each provider type
for elective procedures, relative to 2003/04, by procedure

5. Number of procedures conducted by ISTCs, 2003/04 to 2010/11

6. Number of ISTC sites in operation, 2003/04 to 2010/11

7. Cumulative distribution of GP practice-level concentration for
providers used for outpatient referrals by year, 2006/07 to 2010/11

8. Cumulative distribution of GP practice-level concentration for
providers used for outpatient referrals to NHS trusts, 2006/07 to 2010/11

9. For more information about the Nuffield Trust,
including details of our latest research and
analysis, please visit www.nuffieldtrust.org.uk
For more information about the Institute for
Fiscal Studies, please visit www.ifs.org.uk
The Institute for Fiscal Studies is the UK's
leading microeconomic research institute,
aiming to promote effective economic and
social policies.
The Nuffield Trust is an authoritative and
independent source of evidence-based
research and policy analysis for improving
health in the UK.
© Institute for Fiscal Studies and Nuffield Trust, 2012