Towards a history of choice in UK health policy

Abstract

This paper examines health policy documents from the period in which the NHS was planned through to New Labour's reforms, to examine how the terms 'choice' and 'responsiveness' are used to position both users and the public in particular roles. It suggests that health consumerism is a process that has gradually appeared in the NHS through an extension of the choices offered to patients and the terms on which they were offered. Utilising Hirschman's classic framework of exit, voice and loyalty, we suggest that although there appears to be a strong relationship between the introduction of choice with the aim of securing greater responsiveness, that does not necessarily work in the opposite direction because the analysis of responsiveness suggests that there are other means of achieving this goal other than increasing choice through consumerist approaches to organisation. The implications of this analysis are explored for contemporary health service reform.