Searching for the key to better healthcare

NHS commentator Roy Lilley recently announced that the Health and Social Care Act is dead. In a recent interview with Health Service Journal (HSJ), its demise has even been acknowledged by none other than the Health Secretary himself.

Jeremy Hunt told HSJ’s Dave West that “…choice was not the main driver of performance improvement, contrary to the emphasis placed on it by various governments and senior NHS leaders since the early 2000s… there are natural monopolies in healthcare, where patient choice is never going to drive change.”

Choice was one of the many things that the Health and Social Care Act championed. Allowing for greater competition would mean more choice for patients. Clinical commissioning groups would be free to choose services and providers that best meet the needs of their communities. But as Jeremy Hunt recognises in the interview, choice is not always the best option.

The infamous National Programme for IT has shown us that, in healthcare, one size does not fit all. An idea that works in theory does not always work in practice. A single care record sounds like a great idea; but it may struggle to come into being without the wholesale support of end users.

Patient choice is a similar concept. Patients use and experience the health and social care system in different ways. Shouldn’t they be the ones to decide what is best for them?

In primary care, if time allows, we can research our options and make a choice based on what we find. In this case, choice can be useful. Some patients may want to know about the availability of online appointment booking when choosing a GP, for example.

However, patient choice may not be appropriate for all. For example, when facing an emergency, we often don’t want choice, we just want help in the quickest, best possible way. And the way to help patients in an emergency is to have that choice made for them by the right, well-informed people. Hospitals should be able to choose the systems that help them make those decisions; but this concept of choice is impractical when faced with life or death situations.

Patient choice in A&E shouldn’t be taken away – many patients may well choose to go to a hospital that is least likely to breach the four hour waiting time target, for example. But choice in this circumstance should be treated as an option. Let patients choose to choose, if you will. And as this is optional, it most likely is not the key to improving performance or outcomes of the sector.

So does Jeremy Hunt’s revision of the need for choice spell the end for the Health and Social Care Act? Or is it still very much alive, but just taking a breather?  Either way, it seems that we can at last now move on from the tyranny that was the choice agenda, and look at the sensible application of patient choice.

Choice can be crucial to improving performance in the NHS, but it does not stand-alone. There is no one master key to open all the doors the healthcare system. There are too many different types of doors. The NHS needs to know which set of keys opens which doors, and if there is just one that fits, that’s fine. As a patient, I don’t need to go through the whole set. Just open the door, and let the people inside look after me. That would be my choice.