The future of gastroenterology: patient choice, patient voice.

The policy context for patient choice and public and patient involvement (PPI) in the NHS is set out. Both have become increasingly prominent since 2000. A series of NHS systems and policies have been put in place to enable greater patient choice in the belief that the exercise of choice by patients will influence providers to improve quality. This has had some success in elective surgery. One focus has been the publication of outcome data and this may have led to quality improvement through the inherent competitiveness of professionals and institutions. PPI has suffered from a series of unsuccessful reorganisations of patient involvement organisations but has ensured that most health bodies include patient representatives. Capturing patient experience and providing information to enable patient choice have been constantly developed over this time. A particular framework developed by Angela Coulter is used to review current levels of patient engagement in Inflammatory Bowel Disease (IBD), exploring the extent to which patient choice and patient voice are supported and enhanced within current IBD services locally and in national IBD strategy.1 A 2017 vision of the way in which IBD services might maximise patient choice and patient voice is put forward, based on the adoption of present good practice and current service developments, followed by a few rather more radical thoughts about possibilities for after 2017.