Choice might exclude elderly and vulnerable,warns study

More than two-thirds of patients, including elderly people and those with mental health problems, are in danger of being excluded from the government's choice agenda if it is rolled out in its current format, a new report has warned.

The study, commissioned by the Department of Health's London patient choice project and carried out by patients organisation Health Link, found that choice inequalities could reinforce existing health inequalities by empowering some patients but further disempowering others .

Taking Soundings said people over the age of 65 - who make up nearly two-thirds of patients admitted to hospital - along with people living in poverty and others from ethnic minority groups, might be subjected to 'information disadvantage', which could hamper their access to choice.

'Information disadvantage' would include language difficulties, lack of basic skills or total unfamiliarity with the internet, the study said.

'There is a risk that two-thirds of people who are going to be exerting choice will find it difficult or impossible to do so, ' said Health Link executive officer Elizabeth Manero.

'People who are already frail and dependent are likely to be the people exerting choice, and the systems they currently depend on such as care home staff and mental health key workers are the ones that need to be geared up to support them in choice.'

Other recommendations from the study, which had input from organisations such as Action for Sick Children, the Alzheimer's Society and Mencap, included freephone helplines, free internet access at UK online centres and libraries and a learning package to help people understand choice.

'This is almost the first reform that requires patients themselves to behave completely differently, ' said Ms Manero.

'The NHS can set up all the IT, they can provide all the information, but if it doesn't hit the spot with patients they are not going to make the choices. They are not going to understand it and will just ask their GPs: 'What do you think?'' Health Link patient involvement network member Etta Khwaja said she did not think she would be able to exert choice because she is 'internet illiterate'.

'The people who can access this information will get what they want; they will get the choice and good luck to them. But a lot of people in this country have not got this articulate approach to a lot of things. Those people are going to be left with second best.'

London patient choice project board chair Julie Dent said the role of patient advisers in choice pilot schemes in London had proved important in helping people through the system. She added that people who had participated in the project had taken a 'sophisticated' approach to choice.

'They are interested in quality and reputation, they are interested in clinicians - they are interested in a wide range of issues, but it is about how they access those issues, ' said Ms Dent.

'We have to work doubly hard to make sure we are enabling people to exert their choice and we are not designing systems around one bit of the population.'