Choice of Hospital

Patient Choice

Jonathan Marron5th May 2004

Choice of Hospital

User choice is at the heart of the Government’s agenda for public sector reform

Principles for public sector reform• High national standards and clear

accountability• Devolution of responsibility • More flexibility • Choice and diversity of provision

Choice of Hospital

Why Choice? Two key reasons:

• Meet Rising Consumer demand for more choice and more control over services

• Provide new incentives on the providers of public services to ensure they are responsive to users needs

– and, within Health, we having growing evidence that empowered and engaged patients experience better clinical outcomes

Choice of Hospital

We know patients want more choice within the NHS

0 20 40 60 80 100

Choice of Hospital

More information

Choice of Surgeon

Choice of Alternative Medicine

Choice of Treatment

Public

GPs

NB: Only 3% (8% in over 65s) did not want any of these choices

Source: Mori

Choice of Hospital

Choice for 6 month waiters has shown how choice can incentivise providers to change practice

• Choice at 6 months has lead to:– Greater acceptance of pooled lists and CPAT are

methods of reducing long waiters– Trusts ducking under the “6 month bar”– A 30,000 reduction in the numbers of over 6

month waiters planned for end March 2004 – Changes in clinical practice– Greater acceptance of the importance of choice

to patients

Choice of Hospital

The Public believes that choice will improve services.

Q: Will standards of care rise if there is more choice?

A: Rise: 42%(55% amongst 45-64s) No effect: 43% Fall: 9%

• 50% believe NHS needs reform to allow patients more control

source: Economist/YouGov

Choice of Hospital

Patient choice should become part of the day to day experience of the NHS

Building on the Best sets out the immediate priorities

• giving patients a bigger say in how they are treated

• choice of a wider range of primary care services• choice of where, when and how to get medicines• a choice of hospital and appointment• a greater choice of treatment - starting with

maternity and palliative care

Choice of Hospital

A wide range of choices - an evolution of choice?

Choice of Appointment

Choice of Treatment

Choice of Location/ provider

Increasing:

• Sophistication

• Patient involvement

• Cultural change

Choice of Hospital

Choice of Hospital will be rolled out for patients requiring elective care

• Initially choice for patients waiting over 6 months – relatively small numbers– allows NHS to learn about choice

• By Dec 2005 - Choice at point of GP referral– 10 million patients every year– real impact on system dynamics

Choice of Hospital

Choice at Referral will allow patients to choose when and where they are treated

• Choice of 4-5 Providers• GP will advise on clinical aspects• nhs.uk will provide comparative information• a range of support options will ensure equity• E booking will allow patients to book with

their choice

• Choose and Book programme to support roll out

Choice of Hospital

Patients will have the choice of 4-5 providers

• Patients will be offered a choice once their GP agrees a referral is necessary

• Choice of 4-5 providers, could include– NHS and Foundation Trusts– NHS and IS Treatment Centres– Independent sector hospitals– Extended primary care services (is this a

choice or a precursor?)

Choice of Hospital

A single choice which covers the hospital for outpatient, diagnostis and the final procedure

GP

TreatO/P

TreatO/P

Provider 1.

Provider 2.

AftercareChoice

Choice of Hospital

Assessment services (eg GPwSI, Consultant outreach teams) could offer more choice over “what” treatment as well as “where”

GP

Provider 1.

TreatO/P

TreatO/P

Provider 2.

AftercareChoiceAssess. Clinic

PC services

Choice of Hospital

Assessment Centres/Referral Management Centres will need to offer choice

Key Requirements:• ensure appropriate referrals• enable patients to choose their hospital

and appointment• enable patients to discuss their options

Choice of Hospital

GPs will advise patients. Other Information will also be available

GP/Referring professional• advise on clinical aspects• understands medical

history

nhs.ukComparative information:• Location• Waiting Times• Patient Experience• Quality

E-Booking• will provide details of available clinics• will be based on PCT Choice menu• will provide real time info on available appointments

Choice of Hospital

Different levels of support will be needed to ensure equity

Patient choose and book following conversation with GP

Patient requires support with booking from practice staff

Some patients will need additional support from franchised voluntary groups

PCAs may be needed to reach some patients

Increasing Support

Decreasing

Health

Literacy

Choice of Hospital

System reform needed to respond to choice

• New contracting arrangements– 4-5 providers (perhaps new services to enable

choice)– greater uncertainty on contract volumes– dynamic contracting– new emphasis on risk sharing

• New emphasis on performance– patient judged

• Greater emphasis on ensuring patients are aware of providers strengths (marketing?)

Choice of Hospital

System reform programme is addressing both supply and demand side levers

Demand Side• Patient Choice

Supply Side• Foundation Trusts• Treatment Centres• Independent Sector TCs

Payment by ResultsRewards Success

Encourage responsiveness and innovation

Patients judge Performance

Choice of Hospital

Implementation will follow the roll out of E Booking

Autumn 04 Early Adopters offer choice

January 05 Choice at referral for cataract patients

April 05 Contracts to support choice in place

Dec 05Choice at GP referral fully rolled out