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Greater choice for patients is emerging as the big political idea. In support of patient’s choice, Sir Leahy, the chief executive of Tesco writes ‘Like Tesco, the NHS must accept the consumer is king’ (The Guardian, 5th February 2005). But while there can be little disagreement on the importance of choice as an integral aspect of freedom and dignity, how this can be realised in healthcare requires careful consideration. A fundamental distinction needs to be drawn between patients and ordinary supermarket consumers, for even the most capitalist health service stops far short of encouraging supermarket style consumerism, and there are those who would argue that supermarkets, if anything, stif le choice by inhibiting diversity in favour of mass marketing. Furthermore, healthcare ordinarily responds to need not demand.
This aside, the view of patient as king is not all foreign to healthcare, albeit in a clearly different sense than argued for above. That the health of the patient is the doctor’s primary concern is an ethical principle that defines a framework that is distinct from gauging and providing for demand at a profit. Also, health care organisations have a bigger societal role from which they cannot be easily absolved.
<p>Sir Leahy’s perhaps more important warning is that the success of an organisation depends on its freedom from external intervention in strategic and operational planning, and on the dedication of its staff, which is determined by how they feel about the organisation rather than by rules and targets. Greater local control will thus be a welcome move, but it appears that the success of patient’s choice agenda is dependent on a deeper understanding of the complexities of the health service, its
wider role, its method of funding, and on staff motivation. Taking this into account may allow an integrated approach that builds on rather than conflicts with essential frameworks and values.