Leading article: NHS reform - a sensible choice

This New Year marks a new era for the provision of health care. The long-awaited National Health Service Patient Choice programme became active yesterday. Patients in England will now be offered a choice of at least four hospitals - including private ones - when they are referred for non-emergency operations. There are some glitches in the system to be ironed out. The IT system linking GP practices to hospitals, for instance, is not yet fully up and running. But the path is now clear for the creation of a more responsive and consumer-friendly health service. The days when patients would automatically be dispatched to a hospital of their doctor's choosing are now over.

Establishing patient choice in the NHS does not, of course, create a conventional "market" in health care. Choosing medical care is never going to be like shopping on the high street. Even the most health literate among us will ultimately be dependent on informed advice from our doctors. But this reform still represents a significant power shift away from individual hospitals and into the hands of patients.

There are some legitimate concerns about how the new system will work. It is true that there are likely to be some short-term dislocations. Popular hospitals will be over-subscribed. And marketing by individual hospitals, eager to attract as many patients as possible, will be an increasingly common sight, as we report today. This is a natural by-product of competition. Expenditure on advertising and other promotions that many will regard as a waste of NHS resources is bound to increase. Yet, as long as this marketing is regulated, it will be a price worth paying if it creates a more patient-orientated service.

It is also worth remembering that the experience of localised pilot studies indicates that when an element of choice is introduced, waiting lists fall. Increasing patient choice should, ultimately, increase efficiency. From 2008, when this system will be extended so that patients can choose any hospital in England for an operation and competition is increased yet further, we should begin to see substantial improvements across the board. Opponents of reform are fond of arguing that what patients want is not greater choice but a "good local hospital". But the best way to deliver a decent local service is to maximise individual choice.

There is, sadly, an entrenched mindset in the NHS that believes the service exists for the benefit of its staff, rather than those who actually use it. This has been allowed to go unchallenged for too long. The introduction of patient choice will result in a welcome concentration of minds on how best to serve the interests of the patient.