Rt Hon Lord Lilley

    Some months ago, I highlighted how this government has abolished the last vestiges of patient choice in the NHS. You can no longer choose to be referred by your GP to a hospital with a shorter waiting list than the one selected by your local health bureaucracy ? nor can you choose one with a better success rate at performing the treatment you will need ? nor one nearer your relatives. I argued that if we gave patients more choice within the NHS and made taxpayers? money follow their choice it would drive up quality and efficiency in the NHS.

    Following that article, I received a moving letter from a brave young lady, Helen Smith, explaining from her experience ?why choice is absolutely necessary. As result of meningococcal septicaemia she needed four artificial limbs. Her local hospital could only provide limbs that caused terrible blistering, damage and infection. She found another orthopaedic unit in Dorset that could tailor artificial limbs to her needs. But her Health Authority would not transfer the funds to Dorset, even though she was prepared to pay any extra if they were more expensive. She concludes, ?the only way to improve the service is to allow patients to choose where they want to be treated. Then bad centres will shut down (or improve) and centres of excellence will develop?.

    That reinforced my determination to see if we could help people like Helen ? and everyone who depends on the NHS – by increasing patient choice.

    After researching, discussing with experts and asking Ministers questions, the think tank ?Demos? is to publish my proposals in a booklet called ?Patient Power? on Monday, 19th June.

    The response of Ministers to my questions in Parliament about why they have abolished patient choice has been strangely contradictory. First, they denied that patients ever had the right to choose a hospital. But, of course, in conjunction with their GP, they always had that right. Then Ministers changed tack and said they had not abolished that right in law. But their reforms have stopped GPs exercising it. Finally, Ministers said that patients will not miss losing the right to choose because all hospitals will be made equally good. Some hope!

    That is simultaneously a council for perfection and a recipe for mediocrity. In any case, people may want to choose a particular hospital for non-medical reasons, such as it being easier for their relatives to visit.

    In every other instance where users are free to choose between different providers and money follows their choice that is what forces the provider constantly to improve the quality of service.

    My fear for Hitchin, Harpenden and St Albans is that, even if patients regain the right to choose, they will have lost the local hospitals from which to choose. The mergers between local trusts are clearly the first steps towards merging Hemel with Watford and the QEII with the Lister.

    It is strange we hear nothing about this from local politicians who tried to make political capital out of the closure of St Albans A & E (even though the All Party Campaign which I supported lost because the consultants unanimously backed that merger).

    I am strenuously opposed to any further mergers unless, or until, a study has shown whether previous mergers achieved the better clinical results we were promised.

    But, if ever services do have to merge, would it not be better that mergers result from patients voting with their feet to use a more specialised unit ? rather than as a result of bureaucratic diktat?