The Simon Heng Column

Choice. It’s one of the mantras of this government, when talking about public services. Choice in education, choice in health care, choice in social care.

We have become used to being able to choose between products which do roughly the same thing, but differ in terms of quality, price, effectiveness, convenience or image. Choice assumes a free market, in which demand creates diversity of supply, and the quality of a product is usually reflected in its price.

The success of products in a free market also relies on how well they are advertised. Look at the size of the promotional budget for any commercial organisation: Manchester United’s sponsorship deal with US financial giant AIG is worth 56.5m. It’s certainly not love of football that drives a deal like that.

Is the government suggesting that health care will depend upon brand image and successful marketing, and excess of supply over demand – which is the only time we get real choice – do we really want parts of the NHS to allocate some of their budgets to marketing?

Will we choose health care through advertising, or our GP’s recommendation (who, we hope, already refers us to the most appropriate service)? How can we, with little medical knowledge, probably very ill at the time, discriminate between the four or five specialists that the NHS is meant to offer? For a family on a low income, who want to visit their sick relative, choosing the most local, rather than the “best” service will mean effectively no choice at all.

More than 90 per cent of health treatment is given in the community. In most areas, there is little choice of GPs, let alone district nursing, community physiotherapy or podiatry. There is a huge demand for these local services: how will patients be offered a choice to meet these kinds of needs?

Perhaps the primary care trust will choose through competitive tendering – which would be similar to the internal market. Most of us would rather that the target was sustained quality provision from all health care providers, rather than spurious choices.