The NHS is failing to offer patients a choice of hospital for their outpatient appointments with barely 10% of primary care trusts achieving national targets on choice.
According to the Healthcare Commission’s detailed annual appraisal of how the NHS is performing against national targets, the service is failing to deliver patient choice, including stubbornly low levels of use of the Choose and Book electronic referral system.
Choice has been a central idea of the Labour government’s NHS reforms over recent years. By next April the concept of patient choice is meant to be extended from the current four NHS providers to cover any NHS or private healthcare providers willing to treat at NHS prices.
The full picture of how far away the NHS is from meeting the national target for 90% of patients to be offered a choice of provider at the point of referral is shown in the new ratings from the Healthcare Commission.
By March 2006 GPs were meant to be using the electronic ‘Choose and Book’ IT system to offer 90% patients a choice of four hospitals. Only 11% of PCTs achieved the target, and according to the Healthcare Commission 58% of PCTs badly missed the target.
The commission says that of all existing national targets in 2006/2007 the performance on choice was the worst. It says the performance “would appear to suggest that the challenge of persuading independent practitioners to adopt the new system has been far harder than anticipated.”
Within the poor overall national performance on choice the commission found big regional variations. The South-west did best, with 22% of PCTs achieving the indicator, compared to just 12% of PCTs in the North, 8% in the Central region, and just 5% in London and the South-east.
Roughly 60% of PCTs in the Central region, London and the South-east, and the North failed against the indicator, compared to 39% in the South-west.
In addition to measuring achievement against the March 2006 target for 90% of patients to be offered choice, the commission also reported on how NHS organisations were performing on patients’ recall of being offered a choice of hospital. Nationally just 43% of them said they remembered being offered such a choice.
The performance level against this indicator is almost as poor. Only 9% of PCTs achieved the indicator, while 43% failed.
Regionally, the South-west also performed best again, with 14% of PCTs achieving the indicator, compared to 10% in the North, 8% in the Central region, and again just 5% in London and the South-east. About half of PCTs in the Central region, and London and the South-east failed the indicator, compared to roughly a third in both the South-west and the North.
When these two indicators are combined to give a level of performance for the overall convenience and choice target, only three (2%) PCTs achieve the target, while 106 (70%) PCTs fail the target badly.
The Healthcare Commission concludes that achieving the patient choice target “requires both system implementation and behavioural change.”
It adds: “System implementation is required by both provider trusts and primary care, while PCTs need to ensure that GPs adapt their behaviour in both offering patients a choice of hospital and using the Choose and Book system which has been set up to facilitate this.”
From the evidence available, the commission says system implementation “is more advanced than the behavioural changes required from GPs”.
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