Choice and competition have been at the centre of many of the most ambitious reforms of the last decade aimed at boosting quality and efficiency in the NHS. Yet there has been very little evidence on their impact. A report by researchers at the Institute for Fiscal Studies, commissioned with the Nuffield Trust as part of the new joint programme Understanding Competition and Choice, provides the first insights into how choice reforms implemented under the Blair government in 2006 and 2008 have changed where care takes place. The report shows that there has been a significant fall in the proportion of patients being seen at their local NHS Trust since 2006/07: GPs are increasingly referring patients to a wider range of providers. This has been mirrored by a growth in Independent Sector Treatment Centres (ISTCs), introduced alongside greater patient choice under the last Government. ISTCs are privately-owned centres that treat NHS funded patients. Since 2006/07 ISTCs have taken on an increasing proportion of both outpatient and inpatient care, across a range of different operation and specialities.

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