It's a question of choice for patients

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The coalition government has outlined plans to 'put power and responsibility in the hands of every citizen'. In health care this will mean elected members of the public sitting on the boards of primary care trusts (PCTs) and patients being in charge of both their care and their health records.

It will also mean that patients will be able to choose their GP and – an area of recent research by The King's Fund – be able to choose their hospital, rate that hospital and access detailed performance data online.

But does empowering patients to choose their hospital lead to improvements in services? Patients have had a limited choice of hospital for more than four years and the ability to choose any eligible provider – private or NHS – since 2008. The King's Fund has been working with the Picker Institute Europe, RAND Europe, and the Office of Health Economics to look at the implementation of this policy and what impact it has had on providers. Today we publish a report of that research: Patient choice: how patients choose and how providers respond.

We found that most patients think choice is important, but only half are offered one. Very few patients look at published performance information to help them choose. Most select their local hospital but some patients, particularly those who've had a bad experience, choose to travel to an alternative.

The threat that patients could go to another hospital and the fact that personal experience is a key influence of choice has, in some cases, sharpened the focus of providers on improving the experience for their patients. However, we also found that hospitals are not yet actively seeking to attract new patients as a result of choice.

In the future as tighter economic conditions lead PCTs to curtail demand for hospital services, we expect hospitals to compete more for patients' custom. But the providers we spoke to last year faced high levels of demand and were more focused on meeting the 18-week waiting time target.

Empowering patients to choose a hospital is not yet a strong driver of service improvement within health care; it remains to be seen whether it will be in the future. But choice seems to be what patients want and the coalition government is committed to giving them more of it.


David Colquhoun

Comment date
02 January 2011
It seems to me you are concentrating on the politics not the patient. One of the best changes in recent years for me, as patient, has been the ability to choose hospital and consultant. i do worry, though, about the huge bureaucracy that has grown up round patient-centred care. It might be better if all the reports and meetings were dispensed with and the money spent on making it possible for doctors to spend a bit more time with those who need it.

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