Choice of Hospital Patient Choice Jonathan Marron 5th May 2004.
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Transcript of Choice of Hospital Patient Choice Jonathan Marron 5th May 2004.
Choice of Hospital
Patient Choice
Jonathan Marron5th May 2004
Choice of Hospital
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
Choice of Hospital
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
Choice of Hospital
We know patients want more choice within the NHS
0 20 40 60 80 100
Choice of Hospital
More information
Choice of Surgeon
Choice of Alternative Medicine
Choice of Treatment
Public
GPs
NB: Only 3% (8% in over 65s) did not want any of these choices
Source: Mori
Choice of Hospital
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
Choice of Hospital
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
Choice of Hospital
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
Choice of Hospital
A wide range of choices - an evolution of choice?
Choice of Appointment
Choice of Treatment
Choice of Location/ provider
Increasing:
• Sophistication
• Patient involvement
• Cultural change
Choice of Hospital
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
Choice of Hospital
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
Choice of Hospital
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?)
Choice of Hospital
A single choice which covers the hospital for outpatient, diagnostis and the final procedure
GP
TreatO/P
TreatO/P
Provider 1.
Provider 2.
AftercareChoice
Choice of Hospital
Assessment services (eg GPwSI, Consultant outreach teams) could offer more choice over “what” treatment as well as “where”
GP
Provider 1.
TreatO/P
TreatO/P
Provider 2.
AftercareChoiceAssess. Clinic
PC services
Choice of Hospital
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
Choice of Hospital
GPs will advise patients. Other Information will also be available
GP/Referring professional• advise on clinical aspects• understands medical
history
nhs.ukComparative 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
Choice of Hospital
Different levels of support will be needed to ensure equity
Patient choose and book following conversation with GP
Patient requires support with booking from practice staff
Some patients will need additional support from franchised voluntary groups
PCAs may be needed to reach some patients
Increasing Support
Decreasing
Health
Literacy
Choice of Hospital
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?)
Choice of Hospital
System reform programme is addressing both supply and demand side levers
Demand Side• Patient Choice
Supply Side• Foundation Trusts• Treatment Centres• Independent Sector TCs
Payment by ResultsRewards Success
Encourage responsiveness and innovation
Patients judge Performance
Choice of Hospital
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 05Choice at GP referral fully rolled out