The era of patient free choice arrives

Patient free choice began on 1 April, but despite the official launch full blown implementation of a policy likely to have far-reaching impact on the NHS remains some way off. Jon Hoeksma and Fiona Barr report. 

The start of April saw a major expansion of the government’s policy of providing patients with choice at the point of referral for elective procedures, with the introduction of “free choice.”

Well, very nearly. Although the policy came into force on 1 April, the Choose and Book software upgrades required to deliver free choice won’t be put in place until 12 April. 

Empowering the end user

Despite this, free choice is a truly radical policy. It means that any provider willing to deliver services to NHS standards and at the NHS tariff can be listed in the Choose and Book menu of options available to a patient. “Free choice is a truly radical policy.”

It is also a policy that depends on IT. In the first place, the Choose and Book electronic booking system has been overhauled to deliver it. Two new menus will enable referrers to search services commissioned by their primary care trust using a “search primary care” button or to search all services provided by acute and foundation trusts and the private sector nationwide by pressing a “search all” button.

The national Choose and Book system is only one side of the free choice coin - the other is to give patients clear, reliable information they can use to make meaningful choices between different providers. In many ways, this part of the choice agenda is even more challenging than the appointment booking system.

Rate your local hospital

The government has entrusted Dr Foster Intelligence to set up NHS Choices as a one-stop portal for patients to obtain information on different hospitals and the quality of their services.

The site, which pulls together NHS trust data, includes a “compare hospitals” section that will enable patients to select their procedure, input their postcode and then search for providers, with hospitals listed according to distance from the chosen postcode.

Waiting times, length of stay, readmission rates, MRSA rates, statistics from Healthcare Commission reports, as well as information on such things as car parking are all available. In the future, NHS Choices plans to build up its patient ratings and add in items such as C difficile rates as well as more information on clinical outcomes. "Its long term effects are likely to be disruptive and far-reaching.”

The government believes that NHS Choices is so important to the future of an NHS based around patients exercising informed choices and taking responsibility for their health that it is carrying out an £80 million procurement for the portal.

But will it work?

The big unknown is whether patients will share the government’s enthusiasm over choice, and take advantage to switch providers. The evidence is mixed. The 2005 British Social Attitudes survey found that 65 per cent of people wanted to choose their treatment and 63 per cent their hospital.

However, it is still a minority of patients (45 per cent) who are aware of their right to choose according to the September 2007 Department of Health National Patient Choice Survey.

The government has been a long way out in front of the public on the choice agenda, under both Tony Blair and Gordon Brown; both prime ministers have pursued patient choice as a centrepiece of their NHS reform strategy.

Originally, all patients were to be offered choice at the point of referral by December 2005. In practice, the take up of patient choice has proved slower than anticipated – partly because early versions of the Choose and Book software were clunky and unpopular with GPs.

By March 2006, a revised target meant that GPs were meant to be using Choose and Book to offer 90 per cent of patients a choice of four hospitals. Only 11 per cent of PCTs achieved the target, and an October 2007 Healthcare Commission report found that 58 per cent missed it badly.

Despite this, uptake has been steady and rising. By April 2008, about 50 per cent of all referrals were made using Choose and Book. For free choice to succeed, the government will need to remain committed to a long haul. If it does, its long term effects are likely to be disruptive and far-reaching.