Notes from the field of public involvement

Sunday, 14 August 2005

What "choice" means to patients – Ministers please take note!

“Patient choice” is an NHS reform mantra. The belief is increasing choice of hospitals and other places to be treated will inevitably improve services and push poorly performing institutions out of the market. By the end of 2005, we should be offered a choice of at least 4 providers for elective procedures, including where possible one in the private sector. Later in 2006, this range expands to providers anywhere in the country. Leaving aside serious questions about IT support, affordability and the degree of destabilisation of local services, the real question from the user standpoint is “do patients want this kind of choice?” The evidence is growing that many do want “choice” about how and when they are treated, but it’s not necessarily the kind the government is so keen to promote.

Local quality factors outweigh distant choices
In late 2004, hundreds of patients in Wandsworth PCT completed a “How was it for you?” survey through GP surgeries about their recent experiences of hospital care. Over 700 patient experiences show people overwhelmingly want to go to a good hospital that is close to home, one that is clean and does a good, safe job. The most important factor influencing choice of provider turns out not to be GP advice, but everyday issues about time and distance to travel, hospital reputation, cleanliness and waiting times. Flexibility about when to be seen was important, but the focus for choice was local. A full report is forthcoming.

Which? patient choice survey
Nationally there is also reason to question whether the public really wants to make big choices in health care. Which? published results this month surveying 1,700 people about what “choice” meant. They found little excitement for choosing between alternative hospitals: what the public were more interested in (98%) was being able to access good local services. The same went for GPs: 85% said having good GPs close to home was better than being able to pick one from further afield. It will be interesting to see if this localism loyalty also comes out of the forthcoming consultation on healthcare outside of hospital.

Users confused about “choice” meanings
The Healthcare Commission’s State of Healthcare 2005 Report showed that in areas where people were able to choose quicker treatment when they had waited six months, between 50% and 70% took up the offer. In England, 24,300 people opted for faster treatment while in Wales almost 11,500 people chose alternative hospital for faster care. But focus groups commenting on the report’s findings showed widespread confusion about what choice meant – was it type, timing or place of treatment? More than 75% of people questioned said they wanted more “choice”, but the focus group findings came with cautionary note: “there is a need to look beyond choice of hospital to choices about the types of care and treatment provided, particularly for people living with chronic conditions.” The same applies to many elderly people who want better care at their local hospitals.

What this shows up is patients’ desire to be more involved in and have more control over decisions about how, when, and by whom they are treated (involvement and empowerment issues), not just to decide the “where” question. Choice is more subtle than mere geography. Ministers should listen carefully to that above the drone of the “choice mantra”.

Which? Patient Choice Report:

State of Healthcare 2005:

Opinion Leader Research focus groups report:

Andrew Craig | Send feedback