NHS failing on offering patients choice

Tags: Choose and Book London

18 Oct 2007

The NHS is failing to offer patients a choice of hospital for their outpatient appointments with barely 10% of primary care trusts achieving national targets on choice.

According to the Healthcare Commission's detailed annual appraisal of how the NHS is performing against national targets, the service is failing to deliver patient choice, including stubbornly low levels of use of the Choose and Book electronic referral system.

Choice has been a central idea of the Labour government’s NHS reforms over recent years. By next April the concept of patient choice is meant to be extended from the current four NHS providers to cover any NHS or private healthcare providers willing to treat at NHS prices.

The full picture of how far away the NHS is from meeting the national target for 90% of patients to be offered a choice of provider at the point of referral is shown in the new ratings from the Healthcare Commission.

By March 2006 GPs were meant to be using the electronic ‘Choose and Book’ IT system to offer 90% patients a choice of four hospitals. Only 11% of PCTs achieved the target, and according to the Healthcare Commission 58% of PCTs badly missed the target.

The commission says that of all existing national targets in 2006/2007 the performance on choice was the worst. It says the performance “would appear to suggest that the challenge of persuading independent practitioners to adopt the new system has been far harder than anticipated.”

Within the poor overall national performance on choice the commission found big regional variations. The South-west did best, with 22% of PCTs achieving the indicator, compared to just 12% of PCTs in the North, 8% in the Central region, and just 5% in London and the South-east.

Roughly 60% of PCTs in the Central region, London and the South-east, and the North failed against the indicator, compared to 39% in the South-west.

In addition to measuring achievement against the March 2006 target for 90% of patients to be offered choice, the commission also reported on how NHS organisations were performing on patients' recall of being offered a choice of hospital. Nationally just 43% of them said they remembered being offered such a choice.

The performance level against this indicator is almost as poor. Only 9% of PCTs achieved the indicator, while 43% failed.

Regionally, the South-west also performed best again, with 14% of PCTs achieving the indicator, compared to 10% in the North, 8% in the Central region, and again just 5% in London and the South-east. About half of PCTs in the Central region, and London and the South-east failed the indicator, compared to roughly a third in both the South-west and the North.

When these two indicators are combined to give a level of performance for the overall convenience and choice target, only three (2%) PCTs achieve the target, while 106 (70%) PCTs fail the target badly.

The Healthcare Commission concludes that achieving the patient choice target “requires both system implementation and behavioural change.”

It adds: “System implementation is required by both provider trusts and primary care, while PCTs need to ensure that GPs adapt their behaviour in both offering patients a choice of hospital and using the Choose and Book system which has been set up to facilitate this.”

From the evidence available, the commission says system implementation “is more advanced than the behavioural changes required from GPs”.

Links

Healthcare Commission 2007 Ratings

Readers Comments

So difficult to use

18 Oct 07 21:23

Only today a GP told me of wanting to use C and B, to be certain that a non urgent referral to me went through. The GP persevered and it took 50 minutes on the phone to secure the appointment on behalf of a patient with learning difficulties. Local GPs can no longer refer using C and B to me - only to "the service" - it is too slow, too cumbersome, and does not allow referral to a specific COnsultant. Also it has had no effect on the quality of the referral letter!

Personal Service

19 Oct 07 09:32

So are you saying that you see every single patient referred to you personally. how long are your outpatient waiting list at present? how long were they two years ago?

Personal service

19 Oct 07 10:19

Surely the whole point of CHOOSE and book is that a patient, with the guidance of their GP, can choose a hospital that suits their needs and a Consultant with relevent ecperience/specialty?

If this takes ages (longer than is feasible within a GP appointment slot) then the system is not fit for purpose and should be scrapped.

Choice

19 Oct 07 11:33

There is nothing stopping a GP making a referral to the consultant and/or clinic of the patient's choice - PROVIDED the Acute Trust concerned has set their system up to allow that. It is not Choose and Book which is restricting the ability of the GP rather the Acute Trust who wishes to control their resources themselves.

What if there is only one provider?

19 Oct 07 21:08

Just how can GPs give patients a choice if there is only one hospital that provides the service? with the push towards making hospitals regional 'centres of excellence' how can patients have both choice AND quality services? There are already many hospital specialities that are only available at one hospital in my area.

capability - not choice

22 Oct 07 09:52

As an insider, I can assure you that patients have no idea which choice (if there is any at all in a DGH area) and have no real access to honest and simple quality assessments.

so they ask their GP.

Its not choice that patients want or ask for - its the best surgeon capable of offerring that procedure and they have no way of knowing this.

eg: ENT there are 2 in out region. one is general DGH (Dist gen Hospital) one is a regional centre. the regional centre has a surgeon who specialises in rhinoplasty's of a digfficult nature. the DGH does the routine ones.

howebver the regional centre has a massive problem with finances, lack of beds, long queues and MRSA is strife.

Which one would the patient choose?

well I can't access this information on the public domain as an experienced senior health care professional - so joe public does not stand a chance in locating the information.

Solution ask the GP's advice.

So on the whole -what is the point of this over-complicated software that actually impeded working practice.

An actual Comparison: old letter system - 2 mins referral, 10 mins letter transcription(office) turn around for appointment - 20 minutes.

New system: 10 mins referal -manual letter re-generation 10 minutes. phone calls to sort multiple isues out 50 minutes. patient returns to surgery, password lost 1 week, + 10 mins appointment. phone calls 45 minutes. re-books appointment with correct specialist 30 minutes.

"To err is human; but to really foul things up -you need a computer"

Choice and convenience

22 Oct 07 12:45

The 'Capability - not choice' posting raises some important issues to do with booking and choice. Given the complexity of the scenario (and many others), it's unlikely that many people would be able to make a genuinely informed choice, whether they had all the relevant information at their fingertips or not. And that's just one of the critical weaknesses in the Government's precious choice agenda.

However, it's important to set this against the patient's experience:

Old system: Patient goes to GP and gets a referral (2 mins); letter arrives an unspecified time later (1 week, 6 weeks, 6 months?) containing an appointment at an arbitrary time and date. Patient may or may not be able to make the appointment and may not know how to get it changed.

New system: Patient goes to GP and gets referral (10 mins); they may or may not be offered much choice; patient issued with CAB printout (5 mins), patient goes home and books via phone or online (10 mins); if necessary patient changes or cancels appointment by phone or online (10 mins).

In each case, the best and worst case scenarios may not be that dissimilar. But the new system offers far more potential for flexibility and convenience for patients. Choice in its wider (political) sense is only a small part of this, and arguably, of less concern to patients.

Nonsense and System Quality

22 Oct 07 18:21

Choice is a nonsense really. What makes the Government think that patients know anything about the quality of a clinician - they ask the GP. The GP will know the quality of local clinicians, he/she will not have a clue if the surgeon 150miles away is any good or not so the GP advises go local. On top of this, the system is so slow and unreliable - particularly with Acutes also on the national programme that it is suffering death by a 1000 cuts.

Choose & Book

24 Oct 07 09:36

1. When C&B is as easy an experience as Amazon.co.uk, you won't keep me off it, apart from 2.Our patients have always used the local hospital. Other hospitals are 20 miles away and offer no advantage. They would take the train to London for perceived advantage, but those options are often not available

Choice?

27 Oct 07 12:08

15 years ago I could have sent my patients to any consultant in any hospital in the country. Then the government decided that money should be tied to individual patients and restricted that choice to "local" hospitals. Now I have to list the hospitals to each and every patient at the point of referral. 99% of my patients want to go to the hospital they have always gone to. The nearest one. Oh and most also say - "whichever hospital you suggest doctor". Strange thing that! How much money is being spent on restricting choice and checking to see whether we have listed the magic number of "choices"? In my experience if a patient wants to go somewhere other than their local hospital they make that quite clear to me.

This whole issue is a political invention designed for political ends to spend money the government claims not to have on a system that did not need to exist.

As with most of the changes implemented by various governments over the years each "idea" is designed so that the incumbent secretary of state for health can "leave his/her mark". Healthcare professionals like myself then have to work with warped priorities to the detriment of our patients' care. I would have no problem with the "Choose and book" system if it worked fast and effectively and it allowed me to book my patients with any specialist team in any hospital in the country. That would be choice! It does not, and its generally slow web page loading and refresh times extend my consulting time too much, so our surgery do not use it.

If politicians with one track minds stopped having bright ideas and allowed the NHS to be run free from their interference we would have a healthcare system which would spend considerably more on real patient issues, like dealing with their illnesses and long term health...

Contrary to the average politicians' belief, doctors would actually like to do a good job for their patients and actually do care about their health and well being - but we have little time for crackpot ideas. Give me scientifically trialed and proven systems and ditch the spin!