Headlines: August 11th, 2005

The Consumers Association in its latest ‘Which?’ report exposes weaknesses in the Government’s proposals for greater choice in healthcare. The adoption of ‘choice’ is expected to transform healthcare and the NHS. The claim is that patient choice and market mechanisms will create a modern, decentralised and more personalised NHS that is responsive to consumers’ needs. The Which? report considers the proposals from the consumer’s perspective using new research on consumers’ attitudes and experiences of choice in healthcare.The research revealed that choosing can be an unwanted and overwhelming burden at times of stress and vulnerability. For many, the concept of choice was so alien to their experiences of the NHS that they found it difficult to imagine how it would work in practice. They had little knowledge of current proposals to increase choice and develop new roles for health professionals and primary care services. Many also knew little about how to use these services. Tackling this knowledge gap is crucial if consumers are to understand and use the different options available to them.

A cultural change will also be needed among healthcare professionals and providers for choice to work effectively. The choices open to individual patients will be limited by decisions made by organisations and individual professionals – so-called ‘choice editors’. The choice editors operate at international, national and local levels, and within the individual relationships between professionals and patients. Too often these decisions are made without adequate involvement from consumers and are not made in the best interests of the individual patient or society as a whole. Several measures are needed to ensure patients have real choices: There must be more open and transparent decision-making by the many national bodies and regulators that limit the choices open to individuals. There must also be explicit mechanisms to give patients and the public at large opportunities to influence the high-level decisions that frame the choices open to individuals.

The Which? Report concludes that consumers must have the right information at the right time, and the support to use it, if patient choice is to work for them. The quality and range of information must be improved so that consumers can make truly informed choices about their treatment. Significant additional investment is also required to ensure that information meets patients’ needs, is accessible and covers different services and providers comprehensively.