King’s Fund: choice yet to drive quality

Tags: A Choice GP Information iS King's Fund NHS Choices patientopinion.org.uk Quality

04 Nov 2009

The government’s choice policy has yet to be fully implemented and has yet to drive quality in the NHS, a study by the King’s Fund has concluded.

The results of a survey of patients attending eight NHS trusts and two independent sector treatment centres show that half did not remember being given a choice of hospital and of those that did, just 5% had looked at quality information on NHS Choices or other websites.

Most patients drew on their own experience, advice from their GP and the views of family and friends when deciding where to be treated (41%, 36% and 18%).

“The results show that the implantation of the [choice] policy is not yet complete and that three years after patients were first entitled to a choice of hospital for elective treatment, most do not experience the policy as envisaged,” says the paper by Ruth Robertson and Anna Dixon.

“[Even] where patients said that they were offered a choice... the results show that most patients were not actively comparing hospitals and using performance information to select the highest quality provider.

“These results show that the pre-conditions for the choice of individual patients to motivate hospitals to improve quality – that choice is offered and that performance information is used to select a high quality provider – are in many cases not being met.”

The authors argue, however, that it is worth persisting with choice, since their own results show that when choice is offered 8% more patients go to a non-local hospital than when it is not.

“If replicated across the country, an 8% shift in patient referrals could have a significant impact on activity levels and motivate quality improvement,” they argue.

They also suggest that the key to making choice work as intended will be to make people aware that quality differs.

“Most people assume that all hospitals and doctors deliver care of a similar quality. It will take time for professionals to think and act differently,” they say.

The survey was conducted as part of a larger study of choice that will also look at the experience of GPs and hospitals. The full study will be published next spring.

The survey found that 49% of patients at the study sites remembered being given a choice of hospital, with half being given two options and most of the rest three to five options.

A significant number of ISTC patients apparently failed to realise that they were being treated in the private sector, since 22% of patients at one centre and 49% at another said they had been given no private sector treatment options.

Link: King's Fund

Lyn Whitfield

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Readers Comments

NHS Choices

04 Nov 09 10:49

If choice is to work, we need to revisit the whole referral pathway to build in an opportunity for patients to do their homework.

The current low use of NHS Choices when choosing a hospital is because Choose and Book is normally offered as a completed process during a single practice encounter.

The patient sees the GP, they decide on referral, the GP indicates possible choices, they choose and book. (or sometimes just choose and the patient goes away to book).

At the very least, the choice has been narrowed by the time the patient gets to go on NHS choices but, more likely, the booking is done and dusted without the patient getting a chance to investigate quality of services.

I offer patients the opportunity to go away and check services before activating the referral but most just wish to choose, book and move on without further steps

The other big problem is that many patients wish to balance quality and waiting time. Information on the latter is so poor that it is useless.

As a GP I have found that using Choose and Book to look for appointment slots is the only reliable way to find out real-life waits and it also shows up services with no slot availability. Patients cannot do this and, without the information, the patient can spend time making a choice only to find that, in effect, it is not available.

Not offered a choice by GP

04 Nov 09 14:36

As a patient recently I was not offered a choice by my GP until I asked to be referred to the hospital I work in to reduce my time away from work and to be seen by a surgeon I trusted.

As a health professional I have the knowledge that a choice is available, most patients want to be treated as soon as possible as close to home and there support network as possible. I don't think many want an appointment choice either. Most would prefer to be sent an appointment and arrange there lives around it.

I find patients, of any age, still do not have any interest in surfing the Internet to find NHS Choices, let alone try to make a decision which they have little knowledge or experience to make. They feel the decision should belong to there GP as they must know who is best.

Not just clinical outcomes

paul.dunning@ulh.nhs.uk

06 Nov 09 09:07

Also remember choice is not just about clinical outcomes. When I asked one of my patients who had chosen treament at my DGH when she lives nearer the teaching hospital she stated that she came here because it was easier to park her car.

Choice a mirage

roger.hook@nuneatonandbedworth.gov.uk

06 Nov 09 09:13

For all but a small minority, choice is a mirage. Patients just don't want "choice"; they want a good service, near to home, as soon as possible. GPs realise this and usually do the "choosing" for their patients, who simply find the system annoying/bewildering and potentially delaying.

Choice is wasteful and inefficient

10 Nov 09 09:54

Markets offering choice in the presence of a consumer, who does not have the knowledge required to choose rationally, are inefficient and ineffective. In the USA, a significant proportion of the population remains without adequate health care, yet the country spends more of its GDP on health than any other.

It is time we realised that free-marketeers like Enthoven and members of the King's Fund are wrong. The consequence of these theoretician's ideas is that the costs of healthcare increase for the taxpayer, with only marginal gains. In a recession, these strategies should be dropped forthwith. Even the bastion of free markets - the USA - is having a re-think.

Time and time again, it has been demonstrated that the best survivors of recessions are those that focus on quality assurance. Only by systematically improving processes and avoiding re-work will there be considerable savings to the NHS not only in illness prevented but also in improved staff productivity.

Surely it is obvious that if GPs need to be bribed to use Choose and Book, the solution is entirely wrong. This is an example of a politically driven wrong answer to the wrong problem and represents a poorly advised government, glued to the wrong dogma.