Introduction

“Choice is an important principle for our reform programme” (Tony Blair, 2002, p 28).

This chapter considers the role of ‘choice’ in UK health policy documents, examining the remarkable changes over who is meant to make choices in the National Health Service and what sort of choices they are supposed to be making, especially with regard to New Labour's health policy since 1997. ‘Choice’ is a key aspect of consumerism in contemporary welfare policy; indeed “the maximization of patient choice” is at the top of Nettleton's (1995, p 249) list of what consumerism means in the context of the NHS. But ‘choice’ has meant different things at different times. Given New Labour's recent attempt to place patient choice at the heart of driving reform in the NHS, it is especially salient to compare this initiative with attempts to utilise choice as a policy instrument in the past, and consider what it might mean for the future.

The evolution of the health consumer

In crude, but essentially accurate, terms we can periodise the 1970s as being a time in which we can discern a mounting criticism of public services both from the public and media. This criticism became more vocal during the 1980s amid a move towards a more individualist model of society (Walsh, 1994; Beardwood et al, 1999), paralleled by the resurgence of neo-conservatism and a populist shift from the collectivist ideals of the post-war consensus to a free-market, individualised ideal to self-care, individual responsibility and the decline of the state (Mishra, 1990).