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Patient Choice

Patient Choice. Jonathan Marron 5th May 2004. User choice is at the heart of the Government’s agenda for public sector reform. Principles for public sector reform High national standards and clear accountability Devolution of responsibility More flexibility

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Patient Choice

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  1. Patient Choice Jonathan Marron 5th May 2004

  2. User choice is at the heart of the Government’s agenda for public sector reform Principles for public sector reform • High national standards and clear accountability • Devolution of responsibility • More flexibility • Choice and diversity of provision

  3. Why Choice? Two key reasons: • Meet Rising Consumer demand for more choice and more control over services • Provide new incentives on the providers of public services to ensure they are responsive to users needs • and, within Health, we having growing evidence that empowered and engaged patients experience better clinical outcomes

  4. We know patients want more choice within the NHS NB: Only 3% (8% in over 65s) did not want any of these choices Source: Mori

  5. Choice for 6 month waiters has shown how choice can incentivise providers to change practice • Choice at 6 months has lead to: • Greater acceptance of pooled lists and CPAT are methods of reducing long waiters • Trusts ducking under the “6 month bar” • A 30,000 reduction in the numbers of over 6 month waiters planned for end March 2004 • Changes in clinical practice • Greater acceptance of the importance of choice to patients

  6. The Public believes that choice will improve services. Q: Will standards of care rise if there is more choice? A: Rise: 42%(55% amongst 45-64s) No effect: 43% Fall: 9% • 50% believe NHS needs reform to allow patients more control source: Economist/YouGov

  7. Patient choice should become part of the day to day experience of the NHS Building on the Best sets out the immediate priorities • giving patients a bigger say in how they are treated • choice of a wider range of primary care services • choice of where, when and how to get medicines • a choice of hospital and appointment • a greater choice of treatment - starting with maternity and palliative care

  8. A wide range of choices - an evolution of choice? Choice of Treatment • Increasing: • Sophistication • Patient involvement • Cultural change Choice of Location/ provider Choice of Appointment

  9. Choice of Hospital will be rolled out for patients requiring elective care • Initially choice for patients waiting over 6 months • relatively small numbers • allows NHS to learn about choice • By Dec 2005 - Choice at point of GP referral • 10 million patients every year • real impact on system dynamics

  10. Choice at Referral will allow patients to choose when and where they are treated • Choice of 4-5 Providers • GP will advise on clinical aspects • nhs.uk will provide comparative information • a range of support options will ensure equity • E booking will allow patients to book with their choice • Choose and Book programme to support roll out

  11. Patients will have the choice of 4-5 providers • Patients will be offered a choice once their GP agrees a referral is necessary • Choice of 4-5 providers, could include • NHS and Foundation Trusts • NHS and IS Treatment Centres • Independent sector hospitals • Extended primary care services (is this a choice or a precursor?)

  12. Provider 1. O/P Treat Choice Aftercare GP Provider 2. O/P Treat A single choice which covers the hospital for outpatient, diagnostis and the final procedure

  13. O/P Treat Choice Aftercare Provider 2. O/P Treat Assessment services (eg GPwSI, Consultant outreach teams) could offer more choice over “what” treatment as well as “where” Provider 1. GP Assess. Clinic PC services

  14. Assessment Centres/Referral Management Centres will need to offer choice Key Requirements: • ensure appropriate referrals • enable patients to choose their hospital and appointment • enable patients to discuss their options

  15. GPs will advise patients. Other Information will also be available • GP/Referring professional • advise on clinical aspects • understands medical history • nhs.uk • Comparative information: • Location • Waiting Times • Patient Experience • Quality • E-Booking • will provide details of available clinics • will be based on PCT Choice menu • will provide real time info on available appointments

  16. Different levels of support will be needed to ensure equity PCAs may be needed to reach some patients Increasing Support Decreasing Health Literacy Some patients will need additional support from franchised voluntary groups Patient requires support with booking from practice staff Patient choose and book following conversation with GP

  17. System reform needed to respond to choice • New contracting arrangements • 4-5 providers (perhaps new services to enable choice) • greater uncertainty on contract volumes • dynamic contracting • new emphasis on risk sharing • New emphasis on performance • patient judged • Greater emphasis on ensuring patients are aware of providers strengths (marketing?)

  18. Rewards Success Payment by Results • Supply Side • Foundation Trusts • Treatment Centres • Independent Sector TCs • Demand Side • Patient Choice Patients judge Performance Encourage responsiveness and innovation System reform programme is addressing both supply and demand side levers

  19. Implementation will follow the roll out of E Booking Autumn 04 Early Adopters offer choice January 05 Choice at referral for cataract patients April 05 Contracts to support choice in place Dec 05 Choice at GP referral fully rolled out

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