Michael White on patient choice

As for Ivan Lewis, hitherto a blameless junior health minister of sunny indisposition, he was caught warning Gordon Brown against "losing touch" with the voters. Off with his head! It's hard to establish the precise facts but in his interview with the News of the World website (the mind boggles) Mr Lewis almost certainly thought he was stating the bland and blindingly obvious. So he was. Shadow health secretary Andrew Lansley marshalled some awkward statistics to suggest that deep cleaning is patchy and costly. I'm sure he's right. Never mind.

This week's big story has been Tuesday's major expansion of patient choice, backed by a£90m publicity campaign to chivvy patients and GPs who, so the King's Fund reminds us, have not grabbed opportunities available since 2006 as much as ministers hoped.

The NHS Choices website has been criticised for not yet carrying enough data about clinical care, MRSA rates and waiting times. It is there to allow patients to make what Gordon Brown used sceptically to call informed health choices before he embraced the Blairites' post-2002 case that it is both popular and will drive up standards.

At least the website was up and running when I logged in on Monday, which is more than can be said for Terminal 5. Alan Johnson sounded bullish when interviewed for The Sunday Telegraph by Laura Donnelly, formerly of HSJ.

But how does this week's push affect real voters? I rang a few MPs to find out. What comes across is the distance between the theoretical model for choice and the average voter's understanding. Only Kevin Barron, MP for Rother Valley, volunteered that his constituents like being able to book and choose a hospital, "usually in the South, usually close to where a daughter lives" and that the policy will gradually encourage social services as well as trusts to raise their standards.

Mr Barron is Labour chair of the Commons health select committee so that's not surprising. His Nottingham North colleague Graham Allen was more critical, though keen to promote his city's upcoming "early interventions" initiative and greater NHS democracy.

"You can have a philosophical debate about choice, but as a constituency MP I don't think it makes a difference. The NHS still feels as if it's run by bureaucrats and that big decisions are taken to tick boxes for Whitehall. Patient involvement is still grace and favour," he says.

Hemel Hempstead's MP, Mike Penning, now a Tory health spokesman, brings his own local perspective. After a bitter battle over Hertfordshire hospital reconfiguration, Hemel's 1970s hospital is soon to close, meaning its patients will be obliged to go up the motorway to Luton and Dunstable or south to Watford.

"You can't offer people more choice when they can see physically that it's being taken away," says the MP, who complains that consultation is a "sham" and a "stunt". As in Wiltshire, about which I wrote last week, the local (Tory) overview and scrutiny committee had agreed to the plans. Voters no longer trust ministers, Mr Penning says. No surprise there either then.

As Liberal Democrat health spokesman, Norman Lamb understands the theory, but feels that "up to now the concept of choice has been driven more by the search for efficiency than the development of meaningful empowerment of patients. I don't dismiss it or the value of giving patients real power to make decisions. But it's a very limited concept at the moment, a passive take-it-or-leave it approach".

Graham Allen has been maddeningly full of ideas both practical and scary since he first became an MP in 1987. One is voting for local health boards. Fair enough. The other is to give every newborn a leather-bound book, complete with lock of infant hair and NHS share certificate, welcoming baby to his/her health network. And Boots can pay for it, at least in Nottingham. Thanks, Graham, but I think Comrade Johnson has his hands full just now.