Choice & health..feb06
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Choice & health..feb06
- 1. Choice and Health Inequalities Frances Blunden Principal Policy Adviser, Which? Socialist Health Association 28 February 2006
- 2. Choice: panacea or death knell • Arguments in favour of increased choice — Fundamental to a patient-centred NHS — Modernising the NHS — Driving up standards in the NHS — Providing more flexible and personalised healthcare — Empowering patients and increasing autonomy — Guaranteeing support for NHS from all sections of society — Reducing inequalities — Encouraging a more active role in healthcare • Arguments against increased choice — Privatisation of the NHS by stealth — Increasing inequalities — Choice is irrelevant — Unwanted burden at a time of stress 28 February 2006
- 3. Choice and healthcare • Choice fundamental to healthcare — Informed consent is the legal and ethical basis for any treatment — Health is deeply personal — Our reactions to ill-health and our health needs are particular — We want to retain some control over our healthcare • Choice in healthcare is not new • Health needs are unpredictable • Huge information asymmetries • Impact of choices significant • Consumers lack the confidence to make many healthcare choices • Choice has to be about more than just elective care — Choice of GP, treatments, appointment times 28 February 2006
- 4. Government proposals for choice • Increased choice in elective acute care — Patient choice pilots 2002 for patients waiting longer than 6 months — “Choose and Book” December 2005 • Increased choice in primary care — Choice of GP and GP practices — Widening range of primary services eg Walk in clinics, minor injuries units and expanded NHS Direct — Enhanced roles for existing health professionals — New services and new professionals in primary care • Increased choice about medicines — Reclassification of medicines — New prescribers — New ways of dispensing medicines • Increased choices about treatment 28 February 2006
- 5. Proposals associated with increased choice • Diversity of providers — Increased capacity — New providers — Increased use of the private sector — New roles for health professionals • Contestability between providers • New systems of funding NHS care — ‘Payment by Results’ fixed national tariffs for NHS funded care with the funding following the patient — Practice based commissioning 28 February 2006
- 6. Consumers and healthcare choices • Attitudes to choices about healthcare vary significantly between individuals and different circumstances — Not all consumers have the same capacity or desire to make choices — Consumers want some choices and not others — Consumers want choice sometimes and not at others — The desire for choice may be modified in reality • Not all consumers have the same opportunities for choice • Not all consumers have the same ability to make choices — Access to information and support vital — Tailor to the needs of particular groups • Not all consumers have the same ability to take up choices — Rural areas — Low income consumers 28 February 2006
- 7. Do consumers want choice? • Demand for some sorts of choices, particularly to give: — Convenience — Control — Continuity — Flexibility • Prompt diagnosis and treatment is more important than choice • Proximity is key • Quality and safety are assumed as given • Consumers find it difficult to conceptualise what is meant by ‘patient choice’ • Consumers lack confidence and experience in making some choices 28 February 2006
- 8. Existing experiences of healthcare choices • Existing experiences of choices about healthcare are limited — Previously few opportunities for choice — Choice of GP practice most common — Only 12% had a choice of different hospitals • Little awareness of government proposals to increase opportunities for patient choice — Limited knowledge of ‘Choose & Book’ — Patchy knowledge of new facilities and services — Limited understanding of enhanced roles for nurses and pharmacists in primary care • Health professionals can facilitate or frustrate choice 28 February 2006
- 9. Impact of choice on health inequalities Both positive and negative: • Access to choice for some for the first time • May exacerbate existing inequalities in health & access to care • Potential to create new health inequalities as a result of: — Inequalities in service provision and quality — Choice not offered equally for all services & conditions — Opportunities to make and take up choices are unequal: — Patients with significant healthcare needs — Conditions & treatment needs — Rural areas — Patients who choose not to choose — Patients whose GP does not offer choice • Higher costs of choice for some communities 28 February 2006
- 10. Payment by Results – access and equity • Incentives to cherry-pick • Providing care to the tariff • Providers chosen by more complex patients • Providers serving deprived communities • Providers with higher costs 28 February 2006
- 11. What’s needed to make choice work? • Choice must be part of a wider, strategic policy framework — Market-based approach not enough — Priority must be given to clinical need — Limitations of the private sector • The right choices must be in place • Sufficient resources and capacity in the right places — Market mechanisms will not generate capacity to meet all needs • Measures to guarantee safe and effective services • More fine-tuned system of funding care — Recognition of cost variations for different patients & providers — Financial safety net • Information and support • Targeted measures to address inequalities 28 February 2006
- 12. Information and Support • Improved range of information and at the right level of detail — What services are available? When? How to access? — Quality of services including waiting times, outcome data — Relative risks of treatment — Qualitative data • Improved quality of information and how it’s presented — Up to date — Tailored to needs — Different formats — There is more than just the Internet 28 February 2006
- 13. Measures to address inequalities • Choice must be offered equally and consistently to all • Priority based on clinical need • Positive measures and resources to guide consumers unused to making choices through the process • Support vital for many people to make and take up choices — Patient Care Advisers — Time with GPs and primary care professionals — Help with travel • Safeguards for consumers who choose not to choose • Guidelines to achieve greater consistency in GP referrals • More positive engagement of GPs & other primary care professionals in the process 28 February 2006