Intended for healthcare professionals

Observations Life and Death

The perversion of choice

BMJ 2009; 339 doi: (Published 27 October 2009) Cite this as: BMJ 2009;339:b4435
  1. Iona Heath, general practitioner, London
  1. aque22{at}

    Is the rhetoric of choice any more than a fig leaf of respectability for the pursuit of market forces?

    The NHS Constitution, which was published on 21 January 2009, established “a new right to choice and to information to support that choice.” In its press release, the English Department of Health claimed that “The new right makes choice a core feature of a responsive NHS in the 21st century.” However, the reality is that only state sponsored choices are supported. Patients are allowed to choose the hospital to which they wish to be referred but rarely a named consultant. Fewer and fewer patients are able to choose to register with a small general practice with one or two doctors, and none are able to choose to register with a practice that is not subjected to financial incentives encouraging it to increase in size. Within my practice area, patients will no longer be able to choose the trusted physiotherapy services at the local hospital because, in August 2009, the contract was awarded to a private company.

    In his essay, “The Soul and the Operator,” on the events in Eastern Europe …

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