Patient Choice
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In principle patient choice is a good thing. Patients can assess their own priorities, such as whether they prefer a convenient location or a convenient date for treatment, or whether to seek out or avoid a hospital using innovative or controversial procedures. The Choose and Book procedures being introduced have some good features. For example, if patients are going to have a long wait for treatment, it is better to have an appointment date ten months in advance than to carry on living normally and waiting for an indefinite period and then get a letter asking the patient to confirm the appointment date within two or three weeks, when the patient may be working away or on holiday. Other features are bureaucratic and doctrinaire. Very few patients will be interested in five or more choices. The requirement that one choice should be in the private sector has nothing to do with public demand. Before the time of contracts between commissioners and providers, it was quite common for patients to discuss with their GPs options including referral to hospitals in other areas with shorter waiting times. A return to this less formal system may be more appropriate than the presently planned system. There is no effective patients' choice in any PCT that operates a referral management policy. Patient Choice is an empty slogan when available treatment is constrained by resources in the commissioner's budget and offered according to inconsistent policies between localities. For example patients needing hip replacements will be given a choice of hospitals. But if they are covered by some primary care trusts in Suffolk and they are over-weight beyond an arbitrary threshold, they will not get hip replacements at all. This policy has been extended to Stoke on Trent and Lincolnshire and applied to other lifestyle choices. Some primary care trusts do not offer appointments at local hospitals if they have long waiting times. As the most basic choice is between convenient time and convenient location, this is a denial of choice and for some patients is a worse service than when there was no choice at all. I wrote to the PCTs mentioned in the Pulse article on 11 August 2006. See the replies from Milton Keynes PCT dated 22 August 2006 and from the Leeds PCTs dated 7 September 2006 which are not reassuring. Liverpool (21 September 2006) and Cornwall suggest that the reports are erroneous. For a comment article on the need to moderate choice, see:
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Sheila
Porter-Williams |