Across the UK, many patients face long NHS waiting lists, particularly when it comes to mental health services. In England, however, patients have a powerful tool at their disposal: the Right to Choose.
Unfortunately, this right only exists in England, leaving patients in Scotland, Wales, and Northern Ireland without the same opportunities to speed up or widen access to vital care. But why is that the case—and should it change?
✅ What Is the Right to Choose?
The NHS Right to Choose, introduced in England under the NHS Constitution, allows patients to:
- Choose which hospital or mental health service provider they are referred to by their GP (as long as it’s an NHS-commissioned provider),
- Often select private providers who offer NHS-funded care,
- Particularly apply this to ADHD, autism (ASD), eating disorder, or therapy referrals, where waiting lists can be 12+ months.
Patients can access services like:
- Psy-UK
- Clinical Partners
- Psymplicity
- And other online or national NHS-commissioned services.
This route is especially valuable when local NHS services have huge backlogs.
🗺️ Why Isn’t It UK-Wide?
Each nation of the UK controls its own health policy:
| Country | NHS Body | Right to Choose? |
|---|---|---|
| England | NHS England | ✅ Yes |
| Scotland | NHS Scotland (via 14 Health Boards) | ❌ No |
| Wales | NHS Wales | ❌ No |
| Northern Ireland | Health & Social Care (HSC NI) | ❌ No |
In Scotland, Wales, and NI, you’re typically referred to local services only. There’s no mechanism for requesting a referral to an NHS-commissioned private provider in another region or online.
📉 What’s the Impact?
This has real-life consequences:
- Delays in diagnosis for ADHD/autism can take years in parts of Scotland.
- Young people and adults miss out on early support due to long CAMHS or community mental health waiting lists.
- Parents, students, and workers may suffer academically or economically while waiting for care they could get sooner under Right to Choose.
Meanwhile, patients just across the border in England can be seen within weeks by requesting the right provider.
🧠 Why Should the Right to Choose Be Adopted Across the UK?
Here are five compelling arguments for making Right to Choose UK-wide:
1. Equity for All UK Citizens
It’s unfair that someone in Carlisle (England) can access ADHD help in a few weeks, while someone in Dumfries (Scotland), just miles away, waits over a year.
Healthcare rights shouldn’t depend on your postcode.
2. Reduces Long-Term NHS Burden
Delays in diagnosis and treatment often result in:
- Worsened mental health, requiring crisis intervention later,
- School or job loss, which pushes people into welfare systems,
- More expensive treatment down the line.
Early help is cheaper and more effective.
3. Supports GPs and Local Providers
Right to Choose doesn’t remove local services—it supports them by reducing their caseload. It gives GPs more flexibility to help patients instead of feeling stuck within rigid local referral systems.
4. Promotes Patient Autonomy and Dignity
People know when they’re struggling. Denying them choice adds to the feeling of powerlessness many experience when facing long delays or dismissive services.
5. Encourages Service Improvement Through Accountability
When patients have a choice, providers must improve to remain competitive. While the NHS isn’t a business, accountability through patient voice often improves outcomes.
🚫 Why Hasn’t It Been Adopted?
Governments in Scotland, Wales, and NI give several reasons:
- Preference for publicly delivered, local services,
- Concerns over fragmentation or “privatisation” of care,
- Budgetary limitations,
- Political resistance to adopting English health policies.
But many patients feel these arguments ignore real suffering and the practical benefits Right to Choose has already shown in England.
💬 Final Thoughts
In a truly equal NHS, everyone in the UK should have the same right to timely and appropriate care. The Right to Choose isn’t about privatising health—it’s about ensuring access, dignity, and fairness.
It’s time for Scotland, Wales, and Northern Ireland to seriously consider adopting a Right to Choose model, particularly for mental health and neurodiversity where need is growing rapidly.
📣 Have You Faced Long Waits in Scotland, Wales or NI?
Let us know your story—or contact your MSP, MP, or Assembly Member to push for fairer, faster access to care.
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