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This report is about how people with long-term conditions, and their carers, make decisions around the use of home-based health and social care services. Based on a secondary analysis of 231 in-depth interviews with people who either had Parkinson’s disease or autism, or who had survived heart failure or stroke, or were carers for people with multiple sclerosis or dementia, we found that most people were not offered a choice of service type or provider. This was due to a combination of lack of available, appropriate support and a lack of ‘good’ information. We conclude that, in practice, the principle of choice is illusory.