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Patient Choice: Easier Said Than Done

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Patient choice is King. The NHS Long Term Plan, NHS Constitution, NHS Choices Framework: all of them make crystal clear that choice is a right.

And so it should be. It is fundamentally about autonomy - allowing patients to decide how and when their care is delivered. In other areas of life, from ordering a takeaway to booking a hotel, choice is something we are used to - think Deliveroo™, Tripadvisor™, GoCompare™, Expedia™… the list goes on. In this regard, healthcare is some way behind - but perhaps there is a reason for this.

When we order a pizza, we generally have a personal set of choice criteria built on experience, a good idea of what constitutes a reasonable price, and a recognition that a bad choice only has consequences for the 15 minutes that we are eating it. Unfortunately, healthcare is somewhat of a black box, where understanding quality is difficult and a ‘poor decision’ has more serious consequences.

Informed choice relies upon:

  1. having adequate information, and
  2. being in a position to assimilate this information and communicate a decision

Social care presents a particular challenge in both regards. For point 1, even if information about a specific provider is available, there may be significant heterogeneity in the people delivering care, making quality at the point-of-care difficult to determine.

Moreover, there is evidence that remarkably few patients use formal mechanisms aimed at promoting choice, such NHS Choices, and our own experience suggests a surprising lack of awareness around Care Quality Commission (CQC) inspection reports. Unlike, for example, an instinctive reaction to look at the Ofsted report for a school, many are unaware of the CQC ratings and how to find these.

For point 2, when an individual needs care, they are often in the worst position to be making a choice: tired, stressed and confused. Making an involved decision such as which care provider to use, in a contracted period of time, with little or no prior experience, is difficult.

Saying that we want to give patients choice is easy, but truly enabling choice is hard. And this is precisely why we started CareCompare.

Please note that the views expressed here are those of the author alone and not necessarily those of any other person or organisation

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