Leader: Patients do not want to be seen as consumers

The patient as customer is a concept with which we have all become familiar in recent years. Driven by the rise of the more demanding, internet-savvy patient and the service-orientated culture we now seem to inhabit, the idea that people using health services approach them as consumers has been given much credibility. Indeed, we might all have been brain-washed into that way of thinking.

This was the hegemonic concept driving the research that formed the basis of the White Paper, 'Our Health, Our Care, Our Say', with the result that the questions were framed to reinforce the idea of consumer choice.

But research led by Professor John Clarke of the Open University suggests that the consumer model is wrong and could lead to a skewing of services.

Researchers found that although patients did want more from the health service, they were clear that obtaining healthcare was 'not like shopping'.

In fact, patients were concerned that the consumer-orientated model would take away some of what they valued from health services, in particular the individuality and personal relationships.

The research challenges many of the assumptions on which the current choice agenda is founded, and should give all involved pause for thought.

Those questioned in the research did not equate choice with a list of alternative providers but with flexibility and responsiveness in the way services were delivered.

In other words, it was not about choosing between five hospitals but about how soon an outpatient appointment could be delivered and how easy it would be to attend. It was also important that they felt they could trust those delivering the care.

In terms of general practice, Professor Clarke's findings would suggest that Choose and Book might not meet the needs of patients and that access to GPs in traditional practices will be valued above increased walk-in or partial services. The DoH's research for the White Paper was conducted with one particular vision of service delivery in mind. These findings should should be considered carefully before the DoH institutes wholesale service change.

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