The government’s choice agenda risks increasing inequalities because some groups of patients are more heavily influenced by clinical performance than others, according to a health department-commissioned report.
The study from the King’s Fund, Understanding Patients’ Choices at the Point of Referral, found that patients with formal educational qualifications were more likely to choose hospitals with higher standards of clinical performance. Patients without formal educational qualifications placed significantly less importance on increases in clinical quality above an ‘average’ level.
The report says: “This could widen inequalities of access to high performing hospitals and the ‘market’ signals sent to providers by patients’ choices would be inconsistent.”
The paper was published in the same week that the government launched its extended choice network which widens choice from four hospitals to all NHS Foundation Trusts and, over the next few months, independent sector treatment centres.
The King’s Fund report, co-authored with City University and policy research organisation RAND Europe, was based on the results of a survey of 1000 people in England who have experience of being referred to a hospital for elective treatment in the past five years.
Patients were offered a series of hypothetical choice scenarios and the report examined both the choices made and the trade-offs between the choices.
The report found that although GPs’ advice over which hospital to choose was found to be important. it did not override other information such as information about the performance of hospitals and travelling time. Negative advice from the GP was given a higher weight than positive advice in favour of a particular provider.
The study also found that reductions in waiting times below ten weeks were not valued by respondents and exerted no influence over the choice of hospital.
Peter Burge, senior analyst at RAND Europe, said: “Many patients want and value more choice in health services, but this study exposes real differences in the choices that patients with different levels of education are likely to make. It raises uncomfortable questions about how best to provide a health service that promotes equal access to the best performing hospitals for those in equal need.”
The report suggests that further research could be carried out including a collection of data on revealed preference through Choose and Book.
The launch of the health department’s extended choice menu last week was combined with the publication of a new report from the DH on patient choice. The report, Choice matters: increasing choice improves patients’ experiences, includes a foreword from health minister Andy Burnham and contributions from patients, GPs and practice managers talking about their experiences of the Choose and Book system.
Burnham said: “This report shows that patients’ value being able to choose where to go for their treatment, and the convenience of choosing the time and date of their appointment.
“The report also presents feedback from GPs who have told us that choice has helped deliver improved dialogue with patients. It also clearly indicates the positive impact that the Choose and Book service is having on patients, doctors and the NHS as a whole. GPs have even helped us develop an updated version of Choose and Book."
The DH also announced that it was setting up an independent reference group for patient choice, co-chaired by Professor Mayur Lakhani, chairman of the Royal College of General Practitioners, and David Pink, chief executive of the Long-Term Medical Conditions Alliance.
Documents
Understanding Patients’ Choices at the Point of Referral
Choice matters: increasing choice improves patients’ experiences
Related stories
London project raises questions for Choose and Book
New version of C+B supports ‘extended’ choice