Patient choice falls again

James Gubb, 13 December 2007

In March this year, 48% of patients recalled being offered a choice of hospital for their first outpatient appointment. Since then, in every survey the DH has conducted, this figure has fallen. In the latest survey – conducted in July – it stands at just 43%. This really is quite a feat – though not a very impressive one.

Somehow, in a year when choice has been extended to all willing providers for orthopaedics, when the DH has been preparing to open up the same choice for all electives next year and when the operating framework for the NHS – released today – includes for the first time a Competition Board to guard against monopoly, those being offered the chance to benefit from this new ‘market’ has gone down.
This is a massive problem – the government has spent much time recently trying to persuade us in the policy world that it’s not back-tracking on market-based reform, referring more often than not to the creation of a market for electives. But the benefits will only be realised if choice is being offered and patients are allowed to exercise it.
Without this, the framework for competition – payment-by-results, plurality of provision, competition boards, the lot – may as well not be there. Of course as patients become more aware there have a choice, they’ll push for it themselves, but that depends on them knowing about it in the first place. Unless they happen to read the FT, there’s a good chance they won’t – it’s not something the government or the DH like to shout about too much. More damagingly, it’s not something GPs are particularly keen on promoting either; be it out of attachment to the status quo, out of fear of destabilising existing provider networks, or simply because they don’t feel they have the time to sit down with patients and go through the options. Many PCTs are also too attached to their own provider networks or too much stuck in the habits of block contracting to give the agenda too much attention.
Yet it’s vital this changes. By giving patients a real choice and by using a plurality of providers, the NHS has a real chance to harness competitive pressures to become more innovative, more patient-focused, more efficient and – above all – drive better standards of care.
Perhaps, then, more radical options should be considered to promote it. As the experience with QOF shows, GPs will respond to financial incentives. Given that patient choice is perhaps the only government target that offers a self-sustaining and positive framework for better performance, why not provide a similar incentive here? The NHS shouldn’t blow the opportunity it has.