How can patients be encouraged to become active consumers of healthcare?
Last week we reported on the UK government’s plan to increase the options available to NHS England patients for certain types of out-of-hospital care, in what it hailed as “the largest expansion of patient choice in the NHS in a decade”.
This is the latest in a two-decade-long series of initiatives to increase patient choice in the UK’s NHS. The most significant change came in 2008, when NHS England patients were given the right to choose at the point of referral any hospital in the country, including all private ones that have an NHS contract, for consult-led secondary care.
The logic behind these patient-expanding initiatives is clear: if patients can choose who provides the care they receive, they can choose the best quality providers or those with the shortest waits, and this can drive both quality and efficiency at the health system level, and may lead to patients feeling more satisfied and empowered with their treatment.
The problem is that too often these choices go unused. Patients usually aren’t aware they exist and GPs often don’t have the capacity or motivation to offer them. Last year the NHS said only about one in 10 people are exercising their right to choose for consultant-led care.
Darshak Shah recently co-founded a private healthcare provider called Your Patient Choice, in part out of a desire to get patients to make better use of the choices available to them. He pointed out to us that, ironically, patients are showing a willingness to make active choices in where they receive their healthcare from, but this is currently being expressed as choosing to pay several thousand pounds for things like knee and hip replacements, when they could have gone private for free through the choice available within the NHS.
It seems hard to believe that people are unnecessarily paying thousands of pounds to skip NHS waiting lists. Indeed, it is probably rare that someone would be able to get an elective surgery such as a hip or knee replacement immediately by exercising their right to choose through the NHS.
But they could significantly shorten how long they have to wait.
According to a report released in 2022 by the Independent Healthcare Providers Network (IHPN), the UK’s trade body for private healthcare providers, waiting times often vary by months across the country. Because of this, patients could, on average, save 14 weeks of waiting by travelling just 13.2 miles to switch from a poor performing to a top performing provider if they exercised their right to choose.
The problem is that the notion of consumer choice doesn’t mesh well with how Brits, on both the patient and clinician side, think of the NHS — as a monolithic centrally-planned entity which handles all your health issues and makes all the decisions about what kind of care you receive and where you receive it from for you (just very inefficiently). Countries which have statutory insurance-based health systems already have choice built into the system, and so have a somewhat different culture and mindset.
One idea, which Jim Easton, CEO of Practice Plus Group (one of the UK’s largest private providers) believes has the potential to be “transformational” is the idea to make the NHS App the front door via which patients can choose where they receive their care from, instead of having to rely on GPs to offer it to them.
This could certainly help. But there will also have to be a mindset shift in how Brits interact with the NHS.
We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.
