Monday, 4 August 2008

More choose and book nonsense

Despite Choose and Book becoming available to most GP-referred patients to choose a hospital appointment, two thirds of patients surveyed by University College London were given no choice of date or time. Just under a third had no choice of hospital, and 86 percent had a selection of fewer than four hospitals.

Choose and Book started to go live in January 2006, and allows patients referred to hospital by their GPs to choose the location and time they visit, while at the GP surgery, online or on the phone.

It is part of the much-delayed £12.7 billion NHS National Programme for IT, which will replace paper patient data with centrally stored Summary Care Records, provide an electronic prescriptions service, and allow online booking of hospital appointments.

UCL surveyed 104 patients who had used the system for referral to Hillingdon hospital in London, for its report, ‘Does Choose & Book fail to deliver the expected choice to patients?’. Only one patient was offered the four options promised by the scheme.

Patients trying to book online also experienced some technical problems, UCL said. As a result a number of patients were unable to book online, and ended up ringing the booking line or going back to their GP to book the appointment.

The report also warned that there has been “considerable bad feeling associated with Choose and Book with criticism about risks to patient confidentiality, reliability and speed”.

Dr Henry Potts at the UCL Centre for Health Informatics and Multiprofessional Education, who oversaw the study, said Choose and Book was a vital system because patient choice has regularly been touted by the government as central to NHS transformation.

But he added: “It is clear from these results that these patients were not experiencing the degree of choice that Choose and Book was designed to deliver.” This “could be typical” of the system around the country, he said.

The NHS had not even attempted to find out whether patients liked the system, Potts warned. “It is striking that nobody, up until to this point, has actually asked patients about their experience of the system,” he added.

There are also concerns over patients’ understanding of the system, UCL said in its report. Nearly two thirds were not aware they could choose the hospital they visited. Potts said: “This study also raises many wider questions such as what patients understand by choice and, indeed, whether they actually want choice.”

An NHS spokesperson said he recognised the results in the survey, but preferred to point to another a more recent report, which said 67 percent of Choose and Book users were able to go to the hospital they chose.

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