www.publicinvolvement.org.uk

Choice for all - and does it make the tea?

Choices in the NHS, just like tea

After weekend media trails, Patricia Hewitt yesterday unveiled plans for a July launch of "NHS Choices" in association with the ubiquitous Dr Foster Intelligence and backed with a hefty £15m of funding. By implication she also ratcheted up the competition between provider hospitals, foundation trusts and independent treatment centres by encouraging people to vote with their feet - or their mouse clicks - and use the more attractive and better performing ones.  

As a result, some providers, to use that delicate phrase, may decide to "leave the market" if their customer base dwindles.

Bristling with bells and whistles

The patient choice mega-site will bristle with bells and whistles functionality  - searchable directories, with comparative data on hospitals' waiting times, cleanliness and readmission rates, information to help people choose a GP or care home, and multimedia guides to the 40 most common medical procedures and management advice about 20 long-term conditions such as diabetes and asthma. It will even accept patient complaints and comments about hospital experience. These will be "moderated" by an outside company (as yet unnamed) to allow strong feelings that don't name individuals or become offensive or libellous. This could become the hot spot on the site, but we hope this does not detract from the valuable work in collecting patient experiences of health and care being undertaken by Dipex.

With all these features, one is tempted to ask, "will it make the tea if I ask it nicely and put in the right code word?"

Ask your friendly librarian to book you in

From July, online booking of hip operations and other orthopaedic procedures will be possible for any hospital in England as choice is extended.  Those without the web can do it from the local library. Trials have begun in libraries across England: Newham, Bromley, Hackney, Southwark, Haringey, Waltham Forest and Greenwich in London; as well as Derbyshire, Gloucestershire and Suffolk. The idea is that GPs give patients a referral letter listing a choice of hospitals, a password to use choose and book and a leaflet directing them to their local library to make the booking. Let's hope that this proves to be less clunky that the present choose and book procedures.

Perhaps the next logical step is to base GPs in libraries so they can give advice about how to make sensible choices.

If we build it, will they come?

We are all for making as much meaningful information as possible available to existing and potential users of public services, particularly the NHS. Some brave NHS Trusts like St George's Hospital in Wandsworth have taken the lead and are already posting details of their mortality rates from major procedures. Professionals should not have a monopoly on key information and patients and practitioners should be able to use "NHS Choices" together to take informed decisions. 

The test will be, as always, whether patients actually use "NHS Choices" and whether, having had the online "choice experience", they recommend it to others.  The evaluation to be undertaken by Loughborough University will be awaited eagerly for answers. 

The online apotheosis of choice

"NHS Choices" is the online apotheosis of the Government's dogmatic belief in the public's desire to exercise informed choice in its healthcare, spurred on by findings that less than half of patients recall being offered any choice at the time of referral for hospital care. Like most dogma, this is more an article of faith than amenable to reason.  Indeed, reliable survey evidence discussed on this blog as long ago as August 2005 showed that most people wanted more than choice between geographically distinct providers. What they wanted above all was more say and control over what happened to them at high quality local providers. What we said then, we stand by:

"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'."

We hope NHS Choices rises to that challenge.

 For the details of "NHS Choices" see: www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_073790