Patient choice: a systematic approach

The Darzi review’s vision is to create a health service 'based more on patient control and choice', with services becoming 'more responsive' to patients. However, one question remains. If the time has come to take a truly patient-centred approach to choice and responsiveness, what will that mean in practice?

The government, together with thousands of frontline clinicians, has made great strides in eliminating variations in the quality of care. However, one of the true markers of high quality is whether the service provided to each patient is appropriate to their needs. This allows for a wholly different type of variation in care - a variation based on patients' values, preferences and lifestyle. The only way this can be done is if patients are involved in decisions about treatment.

In the UK we have spent the last few years building the choose and book infrastructure needed to support choice of hospital. Meanwhile, there has been too little attention and investment in creating equivalent systems that would engage patients in choosing their treatment.

Involving patients in decisions about their health not only improves their experience of care, but also their outcomes. This revolution cannot happen without the will, belief and commitment of clinicians, but managers also have an important role to play

Empowering patients

Managers' role is to establish systems to support choice of treatment. Decision aids are tools that help and support patients to choose between a number of treatment options. In many clinical situations, there is no right or wrong answer. Decision aids help patients understand the relationship between the choice they need to make and their unique understanding of their own personal circumstances. The patient alone is able to bring expert knowledge of their symptoms, lifestyle, values and preferences to the decision-making process.

The NHS does not need to start from scratch - many tools and systems to support patients with treatment choices are tested and available but there are steps we must all take.

Organisations and managers need to ensure clinicians are supported to develop the specific, technical skills to engage in a partnership approach to decision-making with patients. The decision aids need to be chosen and made available, through CDs for use in patients' home computers, a paper-based tool for use in the waiting room, or - ideally - web-based interactive tools on the NHS Direct website.

Critically, senior leaders will have a key role in building the local will to make this change. Exposing staff to the strength of patients' desire for involvement in decision-making and tracking the impact through clinically compelling measures will be powerful drivers of change.

If Lord Darzi wants to create real patient choice, he can go a long way to achieving this by committing to invest in systems to help patients make meaningful decisions about their care.