Trust, accountability and choice

The emphasis in recent government policy for the NHS in England on the need to increase both the accountability of health care professionals and the choice available to patients have implications for trust relations. However, the findings from empirical research have not only highlighted the continued salience of trust to health care relationships but have questioned the effectiveness of performance management as a means of accountability and the ability of performance data to act as indicators of quality. This research evidence also suggests choice and trust do seem to be related and when choice is exercised it does seem to be based on trust of the doctors' competence and the cleanliness of the hospital mainly derived from indirect or direct experience. Performance information appears to act post the GP referral decision to influence the extent to which patients feel comfortable with the referral rather than actively determining where patients choose to be referred.