What do people think about patient choice?
The NHS Constitution gives people the right to choose where they receive healthcare, and the NHS wants to increase the number of choices available to patients.
We have looked at the stories people have shared with us to find out what people think about being able to make choices about their care.
What choices do patients currently have?
The NHS Choice Framework outlines the options currently available to patients. These include:
- Choosing a GP and GP practice;
- Deciding where to go for a first appointment as an outpatient;
- Asking to change healthcare provider if maximum waiting times are exceeded; and
- Choosing to have a Personal Health Budget.
At the end of October, NHS England announced plans to improve access to care for over 400,000 people. These plans would see those who’ve been waiting for more than 40 weeks for treatment and don’t have an appointment within eight weeks contacted by their hospital to see if they would be willing to travel to another hospital which could treat them more quickly.
Why do opportunities to choose matter?
We have heard that people welcome the opportunity to choose where to have their care:
“I haven't had my hip replacement yet - on a waiting list. But I've been amazed that I've been able to choose to have my op at a local private hospital on NHS, 20 minutes from my home. The alternative was to travel to the NHS unit about 45 minutes away. I didn't want to go to that unit because my mum died there with a hip replacement complication a few years ago. I explained this and was amazed that I was allowed to choose a different hospital, which also happens to be very close. Well done NHS, for giving me patient choice.”
- Story shared with Healthwatch England
How are costs creating barriers to access?
However, for many people, the choice of treatment location means travelling further from their homes and families to receive care. We know that some people can’t afford to travel further afield for hospital treatment.
“Have been waiting almost a year for op for basal cell carcinoma. Will have to travel over 2.5 hours for the procedure. Offered alternative even further away! Concerned about travel costs.”
- Story shared with Healthwatch England
Their families may struggle to afford to visit them in hospital once they recover:
“Caller's 8-year-old daughter is having an operation at a hospital in Brighton. The caller is on low income and can’t afford travel costs to get to Brighton. Would like to know if there is any help she could access with the transport costs.”
- Story shared by Healthwatch East Sussex
Where can the availability of choice improve access to care?
We have also heard that people aren’t offered a choice as to where to receive their treatment. In some cases, this means people have to pay for private care:
“I asked my doctor about choices and he was adamant there was no choice available. I asked him to check with the practice manager which he did. No choice, even though we are in our late 70s and live in rural area not on bus route. Take it or leave it. My family took out a bank loan to pay for private care.”
- Story shared with Healthwatch England
People who live on the boundaries of different health systems appear to experience less choice. They often end up being referred to hospitals which are not the nearest to their home:
“I live in Weardale and I am always sent to Darlington, but I have to drive past Durham Hospital! My friends live in Ouston and are sent to Durham when Gateshead is closer.”
- Story shared with Healthwatch England
We’ve welcomed the NHS’s announcement to inform people of their right to travel further for treatment. However, without a commitment to help people with the costs of travel and accommodation, this will only help those people who can afford to travel.
We call on NHS England and Integrated Care Boards to work together to ensure that everyone choosing to travel for faster treatment is given support, including with the costs of transport and accommodation – as described in the Elective Recovery Plan.
What else are people telling us about choice?
This year, over 4,000 people shared their experiences of personalisation in care with their local Healthwatch. Their feedback highlighted key areas where choice made a difference to their healthcare.
The seven key takeaways were:
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People want flexibility in appointment types, times, and types of professionals they can see. This is often not a matter of personal preference but essential to access due to communication requirements or work or caring commitments.
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People are open-minded about seeing different services or professionals as long as they are informed about their options and these options are genuinely accessible. More could be done to increase awareness of alternative services like NHS 111 First.
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While the choice of service provider is helpful, this is usually motivated by the desire to access care more quickly and is not meaningful if there are significant barriers to accessing all possible services. Commitment to patient choice must be underpinned by improvements to access across the system.
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Continuity of care is more important to some than others but is essential in some areas, like maternity care. Continuity of care does not always have to mean a single professional if there is a sense of continuous service.
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Good communication and being supported to make decisions about their own care is the most important contributor to personalised secondary care, especially while long waiting lists for care are a reality.
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Making choices about their own care is empowering to patients, but these choices need to be meaningful. Private care is not a choice for many, and neither is being given the option of different providers if none have the capacity to treat them.
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Online tools such as referral trackers or texting with GP practices give people a more personalised and continuous experience of care if they are joined up and two-way, allowing people to talk to a real person if they need to.
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