Published: 30/09/2004, Volume II4, No. 5925 Page 4

The government will not 'bottle' tough decisions to close hospitals which 'fail' under patient choice, health minister John Hutton has warned.

Speaking at a fringe conference session organised by the General Medical Council and the Patients Association, Mr Hutton said it was vital that choice for patients was meaningful. This, he said, meant ministers would have to back the choices that patients make - even if that means 'difficult decisions about services and units that patients do not want to go to'.

Mr Hutton said this did not mean hospitals would be consigned to failure at the first sign of difficulty. He told the meeting there will not be a 'nuclear option of closing hospitals down instantly'. Instead, services would be offered help and support, with escalating levels of intervention if a situation worsened. But he was bullish in his insistence that the government will follow the choice agenda to its logical conclusion of closing down unpopular services.

'We are going to be tough about it. A lot of people think we will bottle it at the last minute. We will not. It will be a very different NHS, ' he said.

During the session, which examined the quality agenda and regulation, Mr Hutton made clear his disappointment with the failure of the Society of Cardiothoracic Surgeons to publish surgeonspecific data on mortality rates.

The society had promised to publish individual data this year in line with its commitment in response to the Bristol inquiry in 2001. But when overall mortality data was published earlier this month individual data was not made public, with the society insisting that the poor quality of existing data meant comparisons remained unfair.

Mr Hutton admitted the failure to publish was 'a disappointment', but he insisted the government would work with professions to ensure the promise was kept. 'It is quite a challenge, ' he said, 'but it is the only road we can follow... There is no going back to that world where 'doctors know best'.'

He continued: 'If you wanted to caricature the NHS it is a bit of a secret society. We know things, but we do not tell the public.'

Professor Sir Alan Craft, Royal College of Paediatrics and Child Health president and chair of the Academy of Medical Royal Colleges, was more hesitant, telling the session: 'We are all for league tables, but they have to be about comparing like with like.You often get the case where best surgeons are referred the 'worst'patients.We have got to refine the data - we want to be able to do that eventually... but it is very difficult.'