The current system of elective care is struggling to inform patients of their rights to choose healthcare providers and procedures, and offering little information or support when decisions need to be made, according to a new report. The report, Patient Choice in Elective Eye Care, from Ipsos and Policy Partners, lays out 15 expectations from healthcare providers following a two-day deliberation on elective eye care with a diverse group of 65 Londoners.
These expectations offer a bold and practical roadmap to shape and support the future of patient choice in the NHS, making decision making more meaningful, ethical, and equitable.
The work was funded through NHS England and commissioned by North Central London’s Single Point of Access (SPoA) service, hosted at Moorfields Eye Hospital NHS Foundation Trust.
Over the course of two full-day in-person workshops, participants explored both what drives people’s decisions when choosing a provider - such as waiting times, convenience, and clinical expertise - and the principles that should underpin how those choices are presented.
The 15 expectations were developed through in-depth and facilitated deliberation, with participants weighing up real-life trade-offs and questioning NHS leaders and specialists about what could and could not work in practice.
Participants agreed that people must be clearly told early on that they have a choice and supported in a way that works for them, including the option not to choose. They called for timely, personalised, and proactive support, particularly for people without informal networks or those facing barriers such as language needs, disability, or digital exclusion.
Working together, participants described a model for a predominantly digital service that could:
- Allow users to filter and explore provider options based on what matters to them (e.g. speed, location, expertise);
- Provide accurate, up-to-date information about each provider in a format that is clear and easy to compare;
- Signpost to further details for those who want more in-depth information;
- Offer information in multiple formats, including offline and accessible versions to meet different needs;
- Provide human support for those who need help navigating their options - particularly people who are more vulnerable, digitally excluded, or have additional needs.
Participants emphasised that people must be given enough time to make decisions, without feeling pressured or forgotten. They also set a clear expectation that referrals must be driven by patient need and choice - not financial incentives.
“Patient choice has been a key principle of the NHS constitution for over a decade, but there has been little work to investigate what it means for our patients, and what they really want,” said Dilani Siriwardena, deputy medical director and consultant ophthalmologist at Moorfields Eye Hospital. “This exciting new report has given us a unique opportunity to listen to the voices of our London patients, and hear directly how they want their healthcare services to continue to improve. Importantly, the expectations laid out by the report are transferable to specialities beyond eye care and so could support patients to make truly informed choices about their care across the NHS.”
Patient Choice in Elective Eye Care is to be launched Thursday 12 June at the Royal College of Ophthalmologists as part of an event exploring informed patient choice in eye care and beyond. The report is already being shared with NHS leaders and system partners and will inform the next phase of work to improve how patient choice is delivered in elective eye care, with potential to influence wider services across the NHS. Peter Thomas, director of digital development at Moorfields Eye Hospital, has also received a senior clinician and practitioner research award from the National Institute of Health and Care Research to continue to take forward patient choice work.