Never mind what the sceptics say, patient choice is a powerful policy that will make or break providers, says Stephen Black

The debate about the policy of patient choice often revolves around the idea that patients do not want it: they just want a good local hospital. For some reason the argument that choice is the best mechanism to drive quality improvement falls on deaf ears.

But now that patient choice is happening, the debate has moved from opposition to denial. I have recently encountered a number of important stakeholders in the English NHS who flat out deny that choice will make much difference. The basic myth they articulate is that patient choice is merely a cosmetic policy that will make little difference to where patients are treated. They propose a number of reasons why not. Examples include: GPs choose, not patients; commissioners constrain patient freedom; patients do not have the information to choose; and commissioners will be more concerned with reducing hospital deficits than allowing choice.

Most hospitals are not natural monopolies. Our analysis shows that about 70 per cent of the UK population has a choice of two or more hospitals within 30 minutes of where they live, and about 50 per cent have four or more choices. This is particularly important as the dominant factor in choice is often said to be travel time. Actually, opinion surveys say three things matter a lot: travel, waiting time and clinical quality. Providers must learn just what patients want or they will not retain their revenues.

The NHS does not exist to guarantee the future existence of every hospital, it exists to provide the right treatment for patients. Patient choice will be a painful reminder of this truth to every provider who neglects it.