The government is getting tough over choice. While the other legs of the next stage review - quality and safety - have clear strategies behind them and a sense of momentum, choice has failed to take hold.
It matters for two reasons. Principally it is a patient's right to be allowed to make informed decisions about their own care. In addition, choice will eventually help drive quality.
But the obstacles are formidable. Most patients do not even know they are able to choose their own secondary care provider, and those who do need extensive support to make rational decisions.
The NHS constitution will enshrine patients' right to information on choice. As primary care trusts prepare for tougher financial conditions, Department of Health economists have calculated the cost to each PCT of meeting the constitution's requirements could reach as much as£210,000.
If that is what it takes, the money needs to be spent, and the government needs to prioritise this in its funding settlements. Empowering patients is not an optional extra - it should be central to the values of a 21st century healthcare system.
But the money will be wasted unless PCTs have the levers to ensure all parts of the NHS comply. Crucially, choice will only work if it is embraced by GPs. While many already encourage their patients to express a view about where they should be treated, a significant proportion are obstructing its implementation. They simply do not accept the balance of power needs to tilt a little more towards patients.
HSJ understands the Department of Health is considering introducing compliance with choice into GP contract negotiations. Without some financial clout PCTs will wait a long time for surgeries to make the policy a success. However, any agreement needs to reflect the complex nature of GPs' conversations with patients, not be reduced to box ticking.
But hospitals also need to embrace choice. Wheezes such as blanking out swathes of appointments on choose and book to avoid the risk of breaking the 18 week target may dig a trust out of a short term hole, but in the long run they will prevent choice from promoting the growth of the best services.