1. Choice of Hospital Patient Choice Jonathan Marron 5th May 2004

2. 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

3. 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

4. Choice of Hospital 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 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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?)

12. 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. Aftercare Choice

13. 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. Aftercare Choice Assess. Clinic PC services

14. 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

15. Choice of Hospital 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. 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

17. 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?)

18. 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 Results Rewards Success Encourage responsiveness and innovation Patients judge Performance

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