King’s Fund: choice yet to drive quality

The government’s choice policy has yet to be fully implemented and has yet to drive quality in the NHS, a study by the King’s Fund has concluded.

The results of a survey of patients attending eight NHS trusts and two independent sector treatment centres show that half did not remember being given a choice of hospital and of those that did, just 5% had looked at quality information on NHS Choices or other websites.

Most patients drew on their own experience, advice from their GP and the views of family and friends when deciding where to be treated (41%, 36% and 18%).

“The results show that the implantation of the [choice] policy is not yet complete and that three years after patients were first entitled to a choice of hospital for elective treatment, most do not experience the policy as envisaged,” says the paper by Ruth Robertson and Anna Dixon.

“[Even] where patients said that they were offered a choice… the results show that most patients were not actively comparing hospitals and using performance information to select the highest quality provider.

“These results show that the pre-conditions for the choice of individual patients to motivate hospitals to improve quality – that choice is offered and that performance information is used to select a high quality provider – are in many cases not being met.”

The authors argue, however, that it is worth persisting with choice, since their own results show that when choice is offered 8% more patients go to a non-local hospital than when it is not.

“If replicated across the country, an 8% shift in patient referrals could have a significant impact on activity levels and motivate quality improvement,” they argue.

They also suggest that the key to making choice work as intended will be to make people aware that quality differs.

“Most people assume that all hospitals and doctors deliver care of a similar quality. It will take time for professionals to think and act differently,” they say.

The survey was conducted as part of a larger study of choice that will also look at the experience of GPs and hospitals. The full study will be published next spring.

The survey found that 49% of patients at the study sites remembered being given a choice of hospital, with half being given two options and most of the rest three to five options.

A significant number of ISTC patients apparently failed to realise that they were being treated in the private sector, since 22% of patients at one centre and 49% at another said they had been given no private sector treatment options.

Link: King’s Fund