I suppose it's a generation thing. Choice, that is. And come to think of it, consumer power in general.

I suppose it's a generation thing. Choice, that is. And come to think of it, consumer power in general.

Nearly 60 years ago, when the NHS was founded by Nye Bevan, everyone was grateful just to have the service itself. Never mind choice of hospital or surgeon.

Take NHS-prescribed glasses as an example. Remember those bottle-glass lenses and the Milky Bar Kid-type frames in brown, and brown only? Take it or leave it, that was all that was on offer. Compare that to today's plethora of choice for frame, lenses, style, and fit. I think you get the picture.

When the car was in its early years of development, and Henry Ford was getting into gear as a mass producer, they rolled off the lines at Detroit - and they were all black. As Henry told his customers: 'You can have any colour - as long as it's black!' Droll and to the point, but he wouldn't get away with that today.

Now, the NHS is catching up with the rest of the modern market, with the government decreeing that it should offer choice to the patient in a way that reflects the consumer society we live in, and the level of expectancy of the public. In short, whether we like it or not, the patient is the client. Consumerism rules, okay?

In five years or so, I suspect we will look back and wonder what all the fuss was about surrounding the issues of giving the patient the right to make choices. The reality now is that, like Henry Ford's company, like it or lump it, we have to offer quality and choice by demand and by general government decree. The market factor is here to play its role in the NHS.

Axes to grind

I suppose it was always going to be a case of pain now, gain later. But however we look at it, the NHS is going through a period of gearing up to future realities, getting fit for purpose in the new world of consumerism.

The process of introducing CATS (capture, assess, treat and support) is just one aspect of all this, aiming to put in extra capacity and extra choice to break the log jams in the system by using private providers to work in fields where the acutes can't hit the ultimate 18-week wait target, as, for example, in diagnostics.

Of course, there are axes to grind, and interest can be a factor. Unions are apprehensive about job losses, clinicians about losing working relationships with colleagues they know and with whom they have liaised for many years, and hospitals about their budgets and training requirements. All very understandable concerns during a period of change and adaptation. But we have used such outside providers selectively over the years, and let's face it, private sector firms are usually very focused on quality and safety.

The truth is, we don't have a choice about bringing in choice, and the CATS programme to acheive the 18-week waiting-list target. In East Lancashire, our primary care trust is taking on board the concerns raised by our local hospital clinicians and GPs, and we are adapting and refining the patient pathways to take this into account. No-one could accuse us of producing a basic Model T Ford.