Patients rate good local services above choice

Tags: A Choice Choose and Book DH Government GPs Information iS Quality Standards

04 Aug 2005

A report into patient choice has argued that while Choose and Book is seen by the public as a positive service improvement in the NHS, it does not meet their priorities for healthcare choice.

The report found that the vast majority of patients value having high quality local health services available above choice. Interviewed by Which? 89% of patients put a good local hospital ahead of a choice of places.

The author of the report cautioned that patient choice should not be seen as a a panacea to the problems faced by the NHS and will not automatically improve standards or ensure that people get the sort of care they need.

Consumer body Which? interviewed a series of focus groups for their report, and found that patients wanted to be able to choose the GPs and the consultants they saw and the time of their operation. They also wanted better transport options and wards for people of similar ages with similar conditions; none of which is on offer from Choose and Book, they said.

According to the report the DH's pilots of Choose and Book showed that patients tended to be somewhat erratic in the way they tried to exercise choice; for instance, trying to opt for providers not on the list, or splitting their care between more than one organisation.

"If and when consumers have experience of choosing where they are treated, they may not be satisfied with such limited choices," say the report.

Lack of information about the choices that patients can make and about Choose and Book is a crucial problem, and Which? accused the DH of underestimating this: "We do not believe the Government has fully recognised the restrictions placed on meaningful choice by the lack of reliable and useful information, and the limited ability and willingness of most consumers to use it."

Frances Blunden, author of the report, said: "Increased patient choice is not the answer to all the problems of the NHS. It will not automatically improve standards or ensure that people get the sort of care they need, when they need it."

Blunden added that the information gap needed bridging in order to give patients meaningful choice and to prevent exacerbating existing inequalities. "Better information and support is needed; the regulatory framework for professionals and services must be adapted to the new healthcare environment and a more sophisticated approach in funding individual patient choices is vital. And not least patients should be given the sorts of choices they want to make."

Simon Williams, director of policy at the Patients' Association, told E-Health Insider that he agreed more information was needed: "Patients would welcome choice if it were a genuine choice. We have so little information about the performance and outcomes of hospitals."

People were minded to choose their local hospital for no other reason than it was convenient, he said. "I think that people will travel once they know that not every hospital is the same and not everybody in white coats is the same."

The report added that some sections of the public are intimidated by the idea of choice, feeling that they lacked the confidence to make the decisions and preferring to leave them to healthcare professionals.

"For many, the concept of choice was so alien to their experiences of the NHS that they found it difficult to imagine how it would work in practice," said the report. "They had little knowledge of current proposals to increase choice and develop new roles for health professionals and primary care services."

Which? also found that many people they interviewed were sceptical that the NHS would be able to implement Choose and Book successfully.

Links

Which? report into choice in health [PDF, 575K]

Readers Comments

At last the penny drops

05 Aug 05 11:55

It's about time this made the headlines. I can't be the only one who is tired of this central obsession with 'choice', a false justification for so many plans since the early days of privatisation. Sorry, NHS and DoH leaders, I don't believe for a second your constant claims that "the people tell us that what they want is choice". If they do, show us the survey methodology, the statistics and so on. No, what people want is to be able to get an appointment in the near future, to be able to go into a pleasant, clean hospital and be treated with dignity, to not be rushed by a clinician who is having to keep consultations as short as possible because he/she is under pressure. Please take note of the article above and tackle the real issues.

Ask the users dummy

05 Aug 05 17:50

I am afraid this is typical of systems thought up in ivory towers by non-users. I have been in IT for 30 years + and have seen too many systems like this.

The first principle is to find out from the users, and recipients what they want the system to provide, and to deliver that to them. If you don't do that you stand a very good chance of providing a useless system.

(post edited by EHI)

Choice is 'good' in principle but not if the diagnosis is not known

alan@landmarkconsulting.co.uk

05 Aug 05 19:58

All my experience tells me that 'customer choice' externally and 'the pursuit of excellence' internally are poweful drivers of fundamental improvement in organisations.

Hence, its easy to see why the Government places such store around 'patient choice' in the context of encourageing fundamental improvement within the NHS.

The problem, though, is that giving patients 'choice' over which Consultant to see is meaningless (and potentially disadvantageous) if the most appropriate next step in the 'care pathway' is NOT to wait for up to, say, 17 weeks to see a Consultant.

For instance, a rigorous analysis of demand for orthopaedic referrals conducted last year showed that in only around 40% of cases was waiting to see a Consultant Orthopaedic Surgeon the most appropriate first step for the patients concerned.

Instead, the evidence showed that 60% of patients ought, instead, to be offered more appropriate care, such as urgent physiotherapy, seeing an ESP Physiotherapist, having a predictable diagnostic conducted prior to seeing a Consultant, and so on.

I think the time has come for someone in authority to say, "OK, I see the Emperpor has no clothes", and then we can discuss re-directing the effort of IT development accordingly.

Alan

So I wasn't wrong!

06 Aug 05 18:01

When I first heard about Choose and Book I couldn't believe that the superb concept of electronic booking had been distorted into such a silly idea........ But I was just being reactionary, wasn't I?

When will the bright eyed DH policy wonks come down from their ivory towers and start to think about something really useful, instead of trying to impress politicians by spinning the benefits of unnecessary and unwanted systems?

Everyone forgets about the 'book'

08 Aug 05 12:42

A lot of the comments about Choose and Book focus mainly on the choice element - but what about the book?

It makes entire sense to me for referrals to be attached electronically and for patients to have the opportunity to book their appointment at the same time or just after the consultation with the GP. It means no lost referrals, better patient certainty over next steps, less patient anxiety and is more efficient than the current system.

All the debate over patient choice clouds the issue that the Choose and Book system is easy to use and will bring significant benefits to the patient with or without being offered choice of provider.

Rather than argue about it, can't we put the system out there and get the benefits of patients booking their appointments straight away?