'The government believes the 'where' of care resonates with the public at least as much as the 'how?'.'

The consultation on extending patient choice is an attempt to revitalise a policy that has lost its way, hidebound by struggling technology and more dynamic policy siblings.

The rationale for the original tranche of patient choice was clear - it was a lever to test traditional referral patterns, fuel additional capacity and reward the best providers. There are strong doubts that it has really delivered on any of these things or caught the imagination of the public - the consultation document's evidence in support is weak. Meanwhile, its supporters would claim it has become part of the landscape, impossible to reverse.

What is this new extension of choice intended to achieve? There is little specific about the consultation so far, apart from announcing the six care areas it will cover. There are no hints of the kind of specific commitments that drove the original choice agenda. The overarching theme, however, is the drive to move care out of the acute sector, whether it is antenatal care, mental health assessments, diagnostics or hospice at home. The government believes the 'where' of care resonates with the public at least as much as the 'how'.

There are also elements that together will pull in different directions. For instance, the document emphasises 'beliefs and values' as well as clinical need, but also that choices must be 'clinically appropriate'. Patients must take 'some responsibility for their choices' but at the same time these should not 'prejudice the treatment they receive'.

Will clinically appropriate services that are not supported by popular 'beliefs' suffer as a result? Indeed the balance between individual choices and their cumulative effect on services, not a factor in the original policy, may well prove to be the most interesting debate of all.