The Department of Health has vowed to involve 'as many people as possible' in a national listening exercise about how to expand choice beyond elective care.

The Department of Health has vowed to involve 'as many people as possible' in a national listening exercise about how to expand choice beyond elective care.

The government has made plans to issue a 'framework on choice' in the autumn, which will set out the steps to 2008 and beyond. The paper will cover the expansion of choice in mental health, cancer, maternity and end-of-life care, and long-term conditions, as well as ways to extend choice at different points in the elective care pathway.

Ahead of this it has set up a choice reference group, chaired by Long-term Medical Conditions Alliance chief executive David Pink and Royal College of GPs chair Dr Mayur Lakhani, with members including clinicians, academics, staff and patient representatives and DoH officials.

Last week the DoH tasked strategic health authority choice leads to involve local health economies in the debate. A 32-page presentation seen by HSJ calls for input from staff 'to ensure our focus is on those areas where it adds most value to the patient experience', and outlines some draft ?high-level principles' which might govern the agenda.

But co-chair Mr Pink has expressed concern about the short timescale for the exercise, which ends on 29 September, and admitted that a previous consultation on expanding choice, published in 2003, 'ran out of steam' after being sidelined because of other national policies. Mr Pink was a member of a taskforce on primary care which contributed to Building on the Best, a government command paper published in December 2003, after a consultation which the DoH said reached 110,000 people.

Key ideas in that paper, such as dual registration with GPs, and greater choice of care at end of life, have seen little progress, although some themes - such as the introduction of primary care plurality - have been promoted in later policies.

Mr Pink also voiced concern about the DoH's planned timetable for consultation on choice, given that the reference group was only due to meet to draw up its timetable this week.

Fellow member Angela Coulter, chief executive of patient research organisation Picker Institute Europe, echoed his concerns: 'This consultation seems to be terribly quick - a bit of a fruitless exercise just so the DoH can say that they have consulted.'

She also criticised the membership of the group as being largely made up of DoH officials, and said the current consultation exercises were not sufficient.

'If this is all the DoH are planning to do in terms of consultation then it is really not enough, there are some really complex issues that need to be analysed to extend choice and much more focused groups are needed. If this is it, then it is very disappointing,' she said.

But the DoH denied that the latest listening exercise replicated the 2003 process, insisting the new dialogue would 'build on existing learning'.

Health minister Andy Burnham, who has been charged by prime minister Tony Blair to develop an 'engagement and communications plan' for the NHS by the autumn, told HSJ that the DoH wanted to find out what choice meant beyond elective care.

'We know that a one-size-fits-all approach will not work for everybody. That's why we're talking to the NHS and service users about what choice means in different service areas'.

'Our framework for choice will set out the next steps for choice following on from Building on the Best. This presentation is intended to help that discussion in local economies,' Mr Burnham added.

DoH drafts 'high-level principles' for choice

  • Everyone is entitled to express a choice about their healthcare and services.
  • Choices offered should reflect the individual's beliefs, values and preferences.
  • Choice should be about type of treatment as much as place of care.
  • Choices should be offered at 'decision points' along the care pathway where this improves the patient's experience and is clinically safe.
  • Appropriate information and advice should be available to empower people to make informed choices.
  • Patients exercising informed choices should also take some responsibility for their choices.
  • The choices offered should be affordable with the NHS budget.
  • The choices an individual makes should not prejudice the treatment they receive.
  • The choices offered should be clinically appropriate and in accordance with professional guidelines and meet NHS core standards.