In my previous two posts in outlining the arguments against increasing patient choice and the repercussions of that choice in terms of the flow of resources, I have tried to substantiate that, for a few people, there is a strong moral case against NHS patient choice. But the moral case against choice per se goes strongly against the mainstream grain of our society. In England not many believe that the state should tell us what to do in so many aspects of lives – which clothes to wear, and even which school or college to go to. Equally there are not many who believe that resources should be distributed to organisations irrespective of whether people have chosen to use services from those organisations. Most of us feel that making consumer choices – and having resources follow those choices – are a part of the way in which we live our lives.

I believe there is a logic that says if patients are going to be able to choose between different organisations and different treatments, then the only way they can make that choice real is if there is going to be more than one provider of that care. Choosing presupposes choosing between - which means there must be more than one option. And if organisations that the patients choose between are recompensed for that choice that looks to me a lot like organisations competing for business.