The patient choice programme must not be promoted at the expense of equity, Peter Carter, the Royal College of Nursing's new general secretary, has warned.

Addressing nursing delegates at a commissioning conference on Tuesday, Mr Carter said that 'choice cannot and must not be promoted at the expense of equity'. He said the central issue for the RCN was whether the choice being offered to patients was 'meaningful'.

'Choice has to be exercised within clearly defined borders. If not, there is a real danger that the choices made by one patient could well deny choices to another patient.'

Mr Carter told delegates that the reforms must be 'clinically informed' rather than cost driven and that a clear decommissioning framework and a nationally binding arbitration process was needed for when contracts were challenged or terminated and services reconfigured.