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Government’s choice agenda risks sacrificing equality in the NHS

In moving to empower NHS patients with choice, the UK government is in danger of sacrificing the principle of equality on which the service was founded, warns a researcher in a letter to this week’s BMJ.

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 Adam Ali, a Frank Knox Fellow at Harvard University.

But, if choice is possible then, by definition, differences exist in the quality of care being provided in the NHS, he says, and some are receiving a substandard service that an informed patient would not choose.

He believes that allowing patient choice is likely to exacerbate inequality as some are better positioned to exercise choice - most likely rich and well-educated people. 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 which no informed patient would choose, he concludes.