A competitive market in healthcare provision, where patients are able to choose the hospital they wish to be treated in, and extra money and further freedoms to develop services flow to the best hospitals, was unveiled by health secretary Alan Milburn last week.

In the clearest exposition yet of how the government intends to reintroduce a competitive market, Mr Milburn spelt out his views at the House of Commons health select committee's annual review of Department of Health expenditure.

Replying to questions about patients being able to go to hospitals with shorter waiting lists, Mr Milburn said: 'In most parts of the country, there is a monopoly provider. By and large, people will choose their local provider. Quite rightly. So the local hospital will remain a very important place.

My own view is we do need to see more choice, and we can get there.

'As we get improved IT in two to three years time, we can get to a position where you and your family members can see where the hospital waiting times are least.

'From the patient's point of view, it will provide information about their hospital and neighbouring hospitals, but more important is to empower change in the NHS.'

Mr Milburn then went on to spell out that the best hospitals would be given more resources and freedoms. He said: 'We have got to have the incentives in place, so people who have improved see there is some reward if they get on. Our tendency is to not reward the good, but to bail out the bad.

'From my point of view, sitting at the top of this organisation, I do not have to worry so much about three-star organisations.

The organisations that do work should have more freedom.'

Mr Milburn's outline of the direction of government policy confirmed the thinking behind a confidential review of the NHS currently being undertaken by exCBI director general Adair Turner.

The review, for the prime minister's office, is looking at introducing greater competition in the NHS, as well as radical changes in medical training and staffing roles.

It is running in parallel with a Treasury review, due to publish an interim consultative document next month, which is likely to say that health expenditure will need to rise significantly to fund a comprehensive, high-quality NHS.

The review team held a conference last week which gave evidence about the cost drivers the NHS can expect over the coming decades, such as new technology and population changes. The cost benefits of shortening the length of medical school training and a radical redefining of jobs, looking at whether doctors really need to do all the work they currently undertake, were also highlighted.

Mr Milburn was due to expand his vision of the future at the Fabian Society's Health Policy Forum as HSJ went to press.

Doctor who?

As well as being able to choose between hospitals, patients may soon be able to compare individual doctors. The British Medical Association has been working with the Department of Health on ways of compiling performance indicators, and comparative tables may be published by the end of the year. Mr Milburn told the health select committee he was impressed by the situation in the US where the public can access information on the performance of individual doctors through libraries.