The proposed inquiry
Follow public money through private provision.
What happens to NHS Right to Choose funding after referral?
The investigation asks whether payments can be reconciled with unique patient journeys, completed care, continuing responsibility and sustained outcomes.
Public records can identify providers, contracts, larger payments, registrations and broad referral activity. They do not, by themselves, reveal full provider spending, repeat onboarding, completed care or whether outcomes were recorded.
The proposed starting scope is NHS-funded patient choice activity in England, initially ADHD and autism pathways. The same structure may later be tested on other elective services. One pathway and two commissioners would be examined before any national expansion.
Minimum evidential model
Five links must remain connected.
- 01
Money
What was paid, to which exact legal entity, for which service stage, after credits and recoveries?
- 02
Access
How many unique people were referred, accepted, rejected or returned for more information?
- 03
Delivery
Which clinical contacts and pathway milestones were actually completed?
- 04
Continuity
Who remained responsible for prescribing, shared care, review or planned discharge at six and twelve months?
- 05
Outcome
What defined clinical, functional and patient-reported results were recorded, including missing follow-up?
The working specification proposes a commissioner-generated pseudonymous patient token and a referral-episode identifier as the join key. Public reporting would contain counts, not patient identities.
The financial question
What would count as a possible NHS loss?
No loss should be assumed in advance. The study would separately test duplicate or unsupported payment, payment without the contracted milestone, avoidable repeat onboarding, unrecovered credits, and costs returned to NHS services after an incomplete private episode.
A treatment that does not help every patient is not automatically a financial loss. Cost, clinical appropriateness, completion, continuity and outcome must be measured separately before they are interpreted together.
All calculations would use net payments after credits and recoveries, unique people as well as referral episodes, complete denominators and a visible measure of missing follow-up.
Connection to Drugs & Society
Treatment contains its own chain of knowledge and responsibility.
Patient choice is incomplete if people cannot see what a medicine is for, who selected it, who monitors it and who remains responsible when care moves between organisations.
- 01
Separate administrative intake and screening from diagnosis, prescribing and treatment review.
- 02
Record who made each decision, what regulated role they performed and which qualification or registration applied.
- 03
Follow medication decisions through titration, adverse effects, monitoring, shared care and the responsible ongoing prescriber.
- 04
For controlled or unlicensed medicines, examine the clinic, prescriber, pharmacy, manufacturer, importer and licence chain separately.
- 05
Ask what information patients received about purpose, licensing status, alternatives, risks, monitoring and continuity.
Publication discipline
A suspicion is not a finding.
High cost, foreign ownership or a repeated referral may justify further checks. None establishes fraud, tax evasion, misconduct or unlawful billing on its own.
Observed pattern
A reproducible count or ratio with its source and denominator.
Anomaly
A pattern materially outside contract terms, historical range or a comparable peer distribution.
Supported concern
An anomaly corroborated by contracts, patient journeys, complaints or repeated records.
Verified breach
An authoritative audit, regulatory decision, admission or adjudicated evidence.
Proposed pilot
The first thirty days
- Days 1–5
Fix one pathway, two commissioners, the study period, outcome definitions and provider seed list.
- Days 3–12
Archive the public corporate, regulatory, procurement, expenditure, referral and waiting-time baseline.
- Days 8–15
Pilot the standard information request and revise it for cost, clarity and consistent definitions.
- Days 15–25
Request commissioner and provider extracts through lawful information and contract-audit routes.
- Days 20–30
Build the reconciliation model and an independently governed patient-survey protocol.
If outcome or repeat-onboarding fields are not held, that absence becomes a finding. Any patient survey should fill defined gaps only, use independent governance, protect health data and ask about events rather than asking respondents to decide whether fraud occurred.
Preserved working source
Read the complete research specification.
The supplied 13-page Word document is preserved unchanged. It contains the data inventory, availability grades, commissioner request, patient-survey module, measures, reconciliation tests, reporting routes and dated official source links.
NHS Right to Choose Data Acquisition Survey
England · working research specification · 10 September 2026
Download DOCX · 58 KB ↓Publication of this protocol does not convert its questions into findings. A later evidenced paper will be linked here without replacing the original research frame.