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24Nov

Since 2009 patient choice has been included in the NHS Constitution making it the patients legal right to choose who delivers your healthcare, what treatments you choose to have and the right to the information to help you decide.

The intention behind this was that if patients choose people and services based on good information the quality will improve.

However researchers are divided over whether people can make rational decisions. Some believe that even if the information is clearly summarised individuals have problems understanding it.

Other studies support patient choices saying that decision aids increase knowledge and confidence for the patient.

As a patient do you value the choice or do you feel there is a lack of information available to help you decide?

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One Response to Patient choice on healthcare

  1. Mr Alan Hanger

    I believe people are capable of making their own decisions about patient choice but are prevented in doing so as the choose and book system and commisioners are not providing enough information and are actually supplying misinformation to prevent patients looking outsidede of the NHS for better service providers.

    My wife has experienced an inappropriate delay to treatment due to difficulties encountered by GP’s and consultants with the choose and book system.

    On 19 August my wife was advised at an appointment with her specialist that she would need to undergo another knee replacement as the one he did two years ago at Woodlands Hospital, Kettering had become loose. Woodlands is a private hospital contracted under choose and book. My wife asked if he would admit her to Woodlands again and he replied that he could no longer treat NHS patients at Woodlands. My wife expressed concerns about being treated at Kettering General Hospital as her previous two operations there resulted in hospital acquired infections and there were insufficient staff to meet her basic hygiene needs. He told her he would try to treat her at Woodlands and advised her to contact her GP to get referred through choose and book.

    When she asked her GP to refer her, he stated that he couldn’t and that she would have to contact her specialists secretary, who in turn stated that the referral should come from her GP.

    There was clearly confusion about the referral process so she went back to her GP to inform him. At their weekly referral meeting, the practice decided to send a letter to the specialist. We were not informed about the content of the letter.

    This resulted with my wife receiving a letter from her specialist in which he states:
    “We have been advised that the Primary Care Trust will not finance knee revision surgery as is required by your good self through the Choose and Book system at the Woodland Hospital. I regret, therefore, that if you wish your operation to be done at the Woodland Hospital then it would have to be done at your expense.”

    On Monday 17th October I contacted PALS to ask them why Kettering General Hospital was the sole choice for her operation and they investigated for me. It took until Wed 26th October to receive the following message.

    Dear Alan
    I have spoken to our Choose and Book lead and she has said that if further treatment is required on an operation that was undertaken in a private hospital (in this case Woodlands) then this is not contracted to be done at the private hospital but is undertaken at an NHS hospital. This is the practice nationally as NHS hospitals have the full facilities to deal with further surgery which needs to undertaken after the initial operation.

    I couldn’t believe that any PCT could force patients into their local NHS hospital outside of the circumstances specified on the Patient Choice website so I asked the Business Development Manager from Woodlands if she was aware that former patients needing revisionary surgery were being denied choice to return and were being shipped into Kettering General.

    After investigating the problem she informed me on Thursday 28th October that my wife was able to be treated at Woodlands and asked me to get the referral started with the GP. The next I met her G.P. but was unable to initiate a referral as he still insisted that he couldn’t refer her because of the letter from Mr Barrington stating that the PCT will not finance knee revision surgery at Woodlands.

    He promised he would get in touch with Woodlands to try and get the problem resolved. I asked Woodlands a week later if they would contact him as I hadn’t heard of any progress. On Thursday 10th November The G.P. made a final check with his commissioning lead for approval and he confirmed he would now refer on Monday 14th November.
    During the three months it has taken to overturn the ruling that further treatment has to be undertaken in an NHS hospital, we were given little information about why there was a problem with the referral. Rather than being placed at the centre of her care and being involved, my wife was on the periphery. We had to rely on Woodlands to keep us informed of any progress.

    The main cause of the delay stems from a dodgy ruling by the commissioning lead and the belief by the GP and the consultant that it is futile to challenge the PCT to adhere to the principles of patient choice.

    Clearly at this time of transition the commissioning process is shambolic and needs strong leadership to ensure the PCT is complying with DOH requirements to stop restricting choice and that guidance is freely available to clinicians, commissioning staff, providers and the public. Directions from The Department of Health’s response to the Cooperation and Competition Panel’s report on patient choice clearly illustrates there is a lot of work to be done to make commissioning more transparent and informative.

    I have tabled the following questions to the CEO of NHS Northamptonshire

    • Choice was initially refused as the PCT commissioning lead stated “if further treatment is required on an operation that was undertaken in a private hospital (in this case Woodlands) then this is not contracted to be done at the private hospital but is undertaken at an NHS hospital.” Could you please tell me where I can reference this ruling to substantiate it?

    • If there is such a ruling:

    ▪ What was the catalyst for lifting the block on choice for my wife?

    ▪ Has it been overturned for this particular instance or has choice now been reinstated for everyone requiring further treatment?
    ▪ Was it made locally and if so was it approved by the PCT Board?

    ▪ How long has the ruling been in place and how many patients have been refused choice as a result?

    • From conversation with friends, some have been informed by their consultant that they can’t be treated at Woodlands. Have all or any consultants been told to stop NHS treatment at Woodlands?

    • Was choice initially refused due to revision surgery listed as a “restrictive service” on choose and book?

    • There was a great deal of confusion between my wife’s consultant and GP about where the referral process starts for revisionary surgery. Now that it has been clarified the GP starts the referral, will you be amending the referral guidelines and notifying clinicians to prevent other patients having their pathway inappropriately delayed?

    • If the start to the 18 week pathway is delayed through no fault of the patient, will inappropriate delays be compensated into the referral to treatment time?

    • I had an Arthroscopy at Woodlands last month and was similarly referred to KGH as sole choice until I got it overturned. I have also been denied choice for a previous orthopaedic referral when tertiary referred from the clinical assessment service, even though the PCT had pledged a year earlier to address the issue. Taking into account other people I know who are surprised when I tell them they should have had a choice at their referral, there is a clear trend of patient choice failing.

    • I was given a referral to treatment time of 14 weeks. I have heard that the PCT has imposed a minimum RTT of 13 weeks on Woodlands. Could you please confirm whether a minimum RTT has been set for any non NHS provider?

    • Have the PCT advised GP’s to refer to their local NHS hospital?

    • Is there a list of services available under choose and book that can be accessed by the public? If there is a list does it show services such as Woodlands that have been restricted and the reason why?

    • If a list is not available when will you comply with the DOH requirement to do so?
    The delay to my wife’s referral has been caused because few people are privy to the decisions made about commissioned services and the restrictions placed upon them. Perhaps when the PCT start implementing the recommendations from “The Department of Health’s response to the Cooperation and Competition Panel’s report on patient choice”, the problems that we have encountered will be eradicated. Our experience is encapsulated in the following extract from the report.

    Recommendation 2: Commissioners be required to approve any such restrictions at Board level, and annually publish (eg as part of their annual report or statement of commissioning intentions) details of any restrictions on patient choice they have adopted, the underlying rationale for the restriction, an analysis of its impact and terms of the restriction, including the period for which it will operate.

    DOH Response: Compliance with the PRCC is the responsibility of PCT Boards and the Department agrees that any decisions that would restrict patient choice of provider for elective services must be approved at that level and involve the relevant subcommittee of the PCT Board, where established, to ensure the engagement of emerging clinical commissioning groups. Any such decisions should be taken transparently and published annually, including the rationale, impact and period of operation.

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