Patients rate choice as a low priority

Choice finished near-bottom of a list of 82 priorities shown to patients in a study carried out for the health regulator, the Healthcare Commission.

There were three statements in the inpatient importance questionnaire asking respondents whether they were offered a choice of admission date,  choice of hospital, and information to make an informed choice of hospital. All three questions rated in the ten least important aspects of care to patients.

Only concerns about noise and access to food were rated lower to the survey’s 448 respondents. The survey appears to put a question mark against the government’s high profile policy of giving choice to patients and the resources that have gone into IT systems which underpin the process of offering choice.

At the same time, only 27% of over 80,000 patients who responded to the separate Healthcare Commission’s 2006 inpatient survey said they were offered a choice by their GPs.

The surveys have been released by the Healthcare Commission today, and have found that when surveyed in autumn 2006, patients have given a vote of confidence to the overall care provided by NHS hospitals, with only 2% saying their care was “poor.”

However, rather than being offered a choice of hospitals, patients are more bothered about whether their doctor knows enough about their medical history and can answer questions about their condition and treatment in a way that they can understand.

The Picker Institute, which ran the surveys for the Healthcare Commission, has recommended that the next inpatient survey should not ask about choice, except to find out whether or not patients are being offered choice by GPs.

They comment: “In comparison with other aspects of care, choice (of hospital, admission date and information pertaining to these decisions) is an issue rated low in importance by all ethnic groups. While questions on choice were piloted for inclusion in the 2005 inpatients questionnaire and again considered for the 2006 inpatient questionnaire, it was decided that the national acute survey might not be the most appropriate tool to measure patient experience of choice.

“The 2005 and 2006 surveys were too soon to measure patient choice. The only choice question currently included in the core questionnaire is: “Were you given a choice of admission date?” We suggest this question should be retained but questions on choice of hospital and information provision not be included in the 2007 inpatient survey.”

The results of the study call into question whether new government policy giving patients the right to choose is actually necessary.

According to figures seen by Pulse magazine, the Department of Health has allocated £50m for the choice and booking directed enhanced service (DES).

Under the scheme, practices will receive a reward payment if 60% or more of their patients who respond to a questionnaire agree that they had a discussion about choice with their GP. The full value of the DES is 96 pence per registered patient and comprises two equal components: 48 pence for choice and 48 pence for Choose and Book.

As E-Health Insider reported last month , the future of the for choice and booking DES is still unclear after the initial 31 March deadline, although the prospects of the Department of Health introducing a national scheme now look unlikely.

Dr Jonathan Fielden, chairman of the BMA’s consultants committee said: “This research reflects what the BMA has been saying for several years – patients are clearly more interested in having a say in the kind of treatment they receive rather than where they receive it.”

Peter Carter, general secretary Royal College of Nursing, added: “Asking people if they want more choice is like asking whether they want more peace. Of course they will say ‘yes’. But what people really want is good relations with staff, good quality treatment and good information at the time of treatment.”

The inpatient survey, released today, also showed that doctors were more likely to ‘always’ reply to patients’ questions with answers that they could understand, an increase to 68% in 2006, from 67% in 2005 and 65% in 2002. Eighty-one per cent of patients who underwent a procedure said they were appropriately informed about the risks and benefits.

However, 35% of patients said staff “sometimes or often” gave conflicting information, an increase from 34% in 2005 and 31% in 2002. Of those taking medicines home, 45% said they were not told of possible side effects before leaving hospital.

Dr Fielden added: “We need to build on these results. Consultants always wish to achieve more for their patients, but the truth is innovative and progressive practices are often held back by the overwhelming focus on finance. Consultants, and healthcare workers in general, working together with patients can and do show the way forward, it is the political meddling that gets in the way, diverts attention and leads to so much of the waste.”

The Healthcare Commission inpatient survey is the biggest test of the opinions of patients about NHS hospitals in England.

Anna Walker, Healthcare Commission chief executive , said: “We all hear a lot of negative comment about the NHS, but we must never forget that most patients have consistently rated the overall quality of their care as good or excellent. Staff should remember this as it shows that patients value the good work they do.”

Health secretary Patricia Hewitt added: “This is the public’s real verdict on the state of our NHS today. Staff should take great pride from this endorsement of the care they provide day in, day out.

“When they are choosing a hospital many patients find it helpful to see what other people thought about the care on offer. The Healthcare Commission’s survey is an invaluable insight into what patients really think about the quality of care they receive in hospitals.”