The new options for operations

IN the early days of television, viewers had only one option - the British Broadcasting Corporation. Gradually, over the years, more and more choices became available. First ITV, then BBC2 came along, followed by Channel 4 and then Five. Now the 21st century viewer can choose from dozens of terrestrial, cable, and satellite channels.

A similar process has just begun in the NHS. Instead of a one-size-fits-all, 'take-it-or-leave-it' approach to providing hospital care, the Government is keen on providing a wider choice. Eventually it could mean people from the North-East having the option to travel to any hospital in the country to see a specialist of their choice.

As of January 1, patients across the North-East and the rest of England who need to see a hospital specialist about a medical problem are being asked to choose from four alternative hospitals or clinics.

In many cases the options will be pretty obvious, including their local hospital. But for some specialisms, it might be more attractive to travel much further afield in order to be seen more quickly.

Patients who are concerned about cleanliness, rates of post-operative infections and whether previous patients have been satisfied with the level of care provided will also be encouraged to compare different hospitals for the first time.

For the vast majority of people visiting their GPs, this change will have little impact. But for those who may need to see a specialist for the first time, the way forward will be rather different.

The Government believes that the reforms will lead to a more responsive, more efficient NHS. Ministers are relying on a revolution in information technology to allow the new 'Choose and Book' approach to take off.

In a small minority of GP practices around the country, including a handful in the North-East, some patients can now choose the hospital they want and electronically book the appointment there and then, before leaving the surgery. However, because the overwhelming majority of family doctors are not technically equipped to do this at the moment, most North-East patients in this situation are likely to be simply informed that they now have a choice and given a booklet setting out the pros and cons of the four hospitals or clinics approved by their local primary care trust.

Those with access to the internet at home or in their local library can check out detailed information about the four competing hospitals via a special NHS website.

Those without internet access can either make their choice from the limited details contained in the booklet supplied by their GP or ring a centralised information centre where a specially trained advisor will help them decide which hospital to choose.

Once they make their mind up they can ring a recently created appointment bureau at their chosen hospital and sort out a date and time which suits them.

Andrew Charles, Choose and Book manager for all five County Durham and Darlington primary care trusts, has been working on the new scheme for months. Because it is so wide-ranging it has involved talks with GPs, PCTs, hospital trusts and strategic health authorities.

Every PCT has had to produce its own version of the Government Choose and Book handbook, giving its list of four hospitals or clinics, including some privately run treatment centres.

"The handbook doesn't replace the GP's clinical guidance but it provides a pen picture of each hospital or clinic, giving a wide range of information," says Mr Charles.

"It is meant to provide an at-a-glance guide, giving information about star ratings, how many operations are cancelled, how long you have to wait for an operation, how risk is managed, rate of MRSA infections, how good are public transport connections and so on."

In a bid to keep it simple, many of the indicators are colour coded so prospective patients can make their minds up.

Anyone visiting their local GP surgery in the next few weeks should expect to start seeing copies of the hospital choice handbook. Mr Charles expects that many patients faced with a choice for the first time will want to go away and think about their decision.

"Not many people expect to be referred when they see their GP. While some people might make their minds up straight away, many will want to go home and discuss it with their family, look at their diary and decide what suits them."

Each patient will be given a unique appointment number and password.

This can be used to visit a special NHS website to look up more detailed information about the trusts or to seek advice from a special NHS helpline. When people have made up their minds, they will be able to ring a dedicated appointments number at the hospital or clinic of their choice.

From the point of view of the hospitals, this is an anxious time. While most should retain most of their local residents, a potentially significant minority could decide to vote with their feet and go elsewhere. There are concerns that an unexpected drop in income could damage some local hospitals in a 'winners and losers' scramble. This is acknowledged by Neil Permain, director of operations at the cash-strapped South Tees Hospitals NHS Trust, which runs the 1,000-bed James Cook University Hospital in Middlesbrough as well as the smaller Friarage Hospital in Northallerton.

"We can't be complacent. There will be trusts that will be worried about losing out under this new system but we think we provide a good service to patients. We have good ratings and our accident and emergency waiting times are currently the best in the country," he says.

But he acknowledges that bad publicity about the high level of debt at the trust, which has imposed a recruitment freeze to save money, could influence some patients.

"The worry is that people may see stories about financial problems and think something else is wrong," says Mr Permain. Trusts would have to put contingencies in place to react to changes in demand, he adds.

In general, GPs in the North-East seem to take a sceptical view of the changes. Dr Andrew Oakenfull, a GP in Ferryhill and chairman of Durham Local Medical Committee, points out that before 1985, family doctors could refer patients to any NHS hospital in the country.

"Most people want to be referred to the best local hospital. We are already doing this. This is a big non-event, total fluff and spin," he says.

Dr George Rae, a GP from Whitley Bay who speaks for the British Medical Association in the North-East, is also cautious about the changes.

"The reality is the average patient wants to be seen within a satisfactory time, at a hospital near where they live and receive a quality service," says Dr Rae. "The majority of patients do not want to be going 100 miles down the road to see a specialist."

His greatest worry, shared by many of his colleagues, is the potential damage which could be caused to the fabric of the North-East NHS by bringing in market forces.

"There is huge concern at the potential damage to the hospital system. If you found that people were choosing not to use the local hospital, that would bring the future viability of that hospital into question. This could make health inequalities even worse."

The changes are only the beginning. By 2008 the Government wants to give patients the choice of being seen at any hospital or clinic "which meets NHS standards at NHS costs".

The revolution has begun. No-one knows where it will lead.