Choice in the NHS will fail without exit strategy for the unchosen

Health Minister Andy Burnham disgraced himself this morning on the radio. Subject is 'patient choice' (BBC item), which is to be expanded. In my view, generally a good idea to put the patient and their adviser (usually the GP) in the driving seat - if money follows the patient then suddenly patients matter more to eveyone in the NHS. Whatever anyone says, the NHS is a bastion of producer interest and its staff quite capable of treating you as if you don't exist. There's lots that can go wrong of course, but patient choice is right should be doable. Burnham's disgrace was to fudge the critical question: what happens to places patients choose to abandon? He came up with some weasel words about support from the centre for hospitals that were struggling. But choice will only work if there is a credible exit strategy for places that aren't chosen. Vast sums of money and growing share of national income are at stake - see chart (click to open larger version). Ministers have to be much more careful than they have been about who gets to spend it and how that is decided.