This site is intended for health professionals only

Patient choice agenda “endangers key principle of the NHS”

17 June 2009

Share this article

The UK government’s drive to deliver patient choice jeopardises the principle of equality on which the NHS was founded, an expert has warned.

In a letter to the British Medical Journal, Adam Ali, a Frank Knox Fellow at Harvard University, says: “If choice is possible then, by definition, differences exist in the quality of care being provided in the NHS and some are receiving a substandard service that an informed patient would not choose.”

His comments come as the Obama administration said that US healthcare reform is “on track” and would preserve the right of patients to choose their doctor.

The US healthcare system is driven by the desire for choice whereas the NHS is driven by the desire for equality, writes Mr Ali. But “allowing patient choice … is likely to exacerbate inequality, as some are better positioned to exercise choice – most likely rich and well educated people”, he says.

These people are more likely to be politically active, and thus promoting choice seems an effective way of scoring political points in the guise of making the NHS fairer, he adds.

The fairest approach is to foster a system in which choice is not needed, by improving those services that no informed patient would choose, he concludes.


Do you agree with Mr Ali? Are choice and equality irreconcilable? Your comments (terms and conditions apply):

“Quality of service is only one aspect of choice. Patients may choose to go to another provider for geographical reasons eg, family live in another area and will be able to care for them post-operatively. In my experience patients will stay with local providers because they are the most convenient for families, the GP will know by name the consultant and his/her reputation.  Whether we can afford choice is another matter. While we spend so much time and effort on systems to allow choice, we are reducing the available resources for doing the job!” – Name and address withheld

“Very correctly assessed, but is anyone listening other than the whingers?” – Name and address withheld