PCTs struggling to enable all patients to make choices, The King's Fund says

Primary care trusts (PCTs) are struggling to support all patients in making choices about their hospital care, according to a new survey from The King's Fund. The situation threatens to undermine one of the government's ambitions for patient choice - to make the NHS a fairer service.

The report reveals that two-thirds of the PCTs responding to the survey had not yet carried out any assessment to identify patients who might need support in making choices about which hospital to go to. A similar proportion had not commissioned any new services to support the introduction of patient choice at the beginning of 2006, when all patients needing non-urgent treatment were to be offered a choice of hospital by their GP.

Almost half (67) of the 152 newly configured PCTs responded to the Choice and Equity: PCT survey. Among the key findings are:

  • fifty-eight per cent of PCTs said that they had not conducted any assessment to identify who might need support in making health care choices
  • two-thirds said that they had not commissioned any new services to support choice
  • two-thirds had not told patients that they might be entitled to financial help for transport
  • a minority of PCTs had invested in staff to offer personal support to help patients make choices and used a variety of ways to encourage patient choice, including mailing to private homes and displays in shopping centres.

The King's Fund chief executive Niall Dickson said:

'This policy will only work if patients are able to make an informed choice - the evidence so far shows that the NHS has not done enough to make this happen. More choice should lead to better hospital care but it must be based on giving everyone not only the chance to choose but also the right information and support.'

Report author Ruth Thorlby, The King's Fund Fellow in Health Policy said:

'In developing the patient choice policy the government argued that it would enable all patients, regardless of their background, to enjoy the choices that only a few used to have, which is a very positive aim. At the same time, the government acknowledged that some vulnerable people would still not find it as easy to make choices as other patients. PCTs were given the responsibility for making sure that everyone would have an equal opportunity to choose. This could be by offering extra help where appropriate, for example, to older people, or people with disabilities or language difficulties.

'Some PCTs are providing support, but the majority are not. This is possibly because getting the electronic systems, such as Choose and Book, to work and convincing GPs to come on board, is a bigger priority. While it is too early to tell whether patient choice is creating fairer outcomes for people, ensuring that everyone gets an equal chance to make a choice is already proving testing for the NHS.'

Most of the PCTs that took part in the survey reported that they found it difficult or very difficult to ensure that all patients had a fair chance to choose. Nearly a quarter said that they faced resistance to the policy from GPs, who were reported to be frustrated with ongoing IT problems and lack of information about choice.

The report calls on the Department to Health to evaluate the impact of patient choice on equity, including the efforts of those PCTs that have invested time and effort into supporting as many patients as possible to make choices.

Notes to editors: 

1. For further information or interviews, please contact the King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.

2. The main findings from the Choice and Equity survey are:

  • 67 of the 152 PCTs in England responded to the survey (44 per cent)
  • 58 per cent said that they had not conducted any assessment to identify who might need support in making health care choices
  • two-thirds said that they had not commissioned any new services to support choice
  • two-thirds had not told patients that they might be entitled to financial help to travel to an alternative hospital
  • fewer than 23 per cent of PCTs had made available information on choice to people’s homes
  • 42 per cent had developed other forms of information for patients
  • 55 per cent said that it was the responsibility of GPs to advise patients about choice.

3. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.