Patients will from today have a choice of free treatment in up to four hospitals - including one in the private sector - in a change that the government hails as one of the most fundamental reforms since the NHS was created nearly 60 years ago.
The move - seen as meeting one of Tony Blair's key pledges for more consumer choice in the public services - is controversial among some Labour backbenchers and was yesterday attacked by the Liberal Democrats and unions, who believe it could force unpopular hospitals to close.
But for Patricia Hewitt, the health secretary, today's change is the key to securing a permanent improvement in the NHS. She said: "Patients have new rights over their own healthcare. These rights will allow patients to choose services which best meet their individual needs."
Ms Hewitt said choice would drive improvement, encouraging hospitals to get better to pull in more patients. "It will get the less well performing hospitals to raise their game because they will see they will be falling behind in attracting patients compared to other hospitals," she said.
She added: "Choice will only work to the full if patients exercise their new rights to choose. It will take time for everybody to get used to the new systems, but I am confident the benefits will be worth it."
But the Liberal Democrat health spokesman, Steve Webb, said the move would benefit the rich and the well informed at the expense of other patients. "People want more control over their care, but the government's obsession with markets will mean the least well advised patients could well end up with inferior care.
"It is clear wealthier people, and those with access to better information about the quality of services, will be able to get access to the best care. Turning the NHS into a giant marketplace creates winners and losers. The downside of shopping around is that some hospitals will go bust."
Trade unions such as Unison and Amicus, which both represent health workers, have been critical of the policy, which they see as linked to the part-privatisation of healthcare.
Andrew Lansley, the shadow health secretary, said: "So far this reform has been costly, unworkable and failed to deliver for patients. The system is not user-friendly and it's plagued by software problems. The government failed to consult adequately with GPs before the programme was rolled out ... Healthcare and IT experts warned the government about the problems months ago, but nothing was done. We need greater transparency to ensure the system works for GPs and patients."
To provide patients with the information they need to choose between hospitals, the government is distributing locally customised leaflets describing the options in each primary care trust area.
Examples were circulated to the media yesterday. They describe the services offered by each NHS hospital on the local choice menu, showing how they scored in the latest annual performance rating. For example, a patient in Durham City has six choices of where to go for general surgery. One is the NHS foundation hospital in Gateshead, which has an excellent rating on waiting times and cleanliness, but a poor score for cancelled operations. Another is the County Durham and Darlington Acute Hospitals NHS trust, with a score of good or average under most headings, but a poor standard of cleanliness, access and information provided.
Residents of Easington, County Durham, have fewer NHS hospitals to choose from, but the PCT is offering general surgery at the Bupa private hospital in Washington (County Durham) or the Cleveland Nuffield private hospital in Stockton-on-Tees. The leaflet does not include performance data on the private hospitals.
Patients may choose a hospital during a consultation with the GP, or may be given a booking reference number, allowing them time to think about the best time and place for an appointment. Those taking their time will be able to make a booking by contacting the hospital by phone or internet and choosing an available slot in the consultant's schedule.
Ministers had hoped an electronic system, known as Choose and Book, would have been installed by now throughout England, linking every GP's computer terminal to the relevant hospitals' appointment registers.
The scheme - part of a £6bn investment in IT across the NHS - is already working in some areas, allowing an appointment to be made by the GP at the click of a mouse. But it will not be available nationwide until the end of 2006. Richard Granger, head of the NHS IT programme, has blamed the delay on frequent changes of specification requested by the Department of Health.
The transitional system may require patients to wait on the phone while a hospital call centre logs their particulars before offering a booking. But this may be less tiresome than the old system that typically involved a delay of a fortnight for the GP and hospital to communicate by letter - often resulting in the offer of an appointment at an inconvenient time.
