The government’s flagship policy of improving patient choice seems to be taking a lot longer to infiltrate National Health Service culture than originally envisioned, findings of a patient survey by think-tank The King’s Fund indicate.

Back in 2006 patients were first given the possibility of choosing from at least four different providers for outpatient hospital treatment, and from April last year these powers of choice were extended so that any hospital in the country could be elected.

The crux of this strategy was to catalyse service improvement by throwing a little competition into the process, the idea being that by allowing patients to cherry-pick those hospitals performing best would hopefully motivate those not doing so well to address any problems.

However, a survey carried out by The King’s Fund as part of a wider research project into patient choice commissioned by the Department of Health found that just 49% of patients visiting their family doctor reported being offered a choice of hospital, and of these 49% said they were given just two options and only 2% were given the choice of five different providers.

According to the report, only 8% said they were offered private sector options and, interestingly, a significant number of patients electing Independent Sector Treatment Centres did not know they were run by private companies, with 48% treated at one such centre reporting that they had not been offered the choice of a private provider when this was clearly not the case.

It was also found that patients turn to various sources of information in making their choice of hospital for treatment, but while 65% of respondents had internet access only a mere 4% said they had visited the NHS Choices website, with the majority basing their decisions on personal experience (41%) and GP advice (36%). However, the authors of the report note that NHS Choices has recently been upgraded with new tools and information to help patients make more relevant comparisons that could increase the flow of traffic to the site.

Perhaps unsurprisingly, the survey revealed that cleanliness, quality of care and the standard of facilities available are the issues considered most important by patients in making their choices, but waiting times – once a huge healthcare headache in the UK – only ranked number seven on the list, presumably as the 18-week referral-to-treatment target has now significantly reduced the referral to outpatient timeline, the authors suggest.

According to the report, the findings, which only give the patient’s perspective on choice at the point of referral, demonstrate that the government’s patient choice agenda has not yet been fully implemented, and that “three years after patients were first entitled to a choice of hospital for their elective treatment, most do not experience referral as the policy envisaged”.

Dr Anna Dixon, report co-author and Director of Policy at The King’s Fund, remarked: "There is still some way to go before choice is fully embedded in the NHS”, as patients are not yet actively comparing hospitals or using performance data to select the highest quality provider despite a wealth of information available to them. And she stressed that “If policy makers want patient choice to drive up quality more needs to be done to let patients know this information is available and make the data relevant, accessible and easy to use”.

The larger research project will also look at GP and hospital perspectives for “a more thorough” assessment of patient choice is taking off and affecting service quality, and final findings will be published early next year.