'Choice, Responsiveness and Equity' consultation

9 December 2003

On 11 February 2003, the Secretary of State for Health, Alan Milburn, gave a speech – ‘Choices for All’ – to NHS Chief Executives that focused on the importance of increasing choice within the health service.

As part of that narrative, he announced the extension of the first choice pilots. He outlined that, from the summer of 2003, all patients waiting more than 6 months for any form of elective surgery in London would be offered the choice of an alternative hospital.

From July 2003, patients in West Yorkshire needing eye operations would be offered choice by their referring GP. In Greater Manchester, those waiting longer than 6 months for orthopaedic, ear, nose and throat, and general surgery would be offered a choice of provider. Also, from July, choice would be extended to patients needing cataract operations in the south of England, who would be able to choose from two and then four hospitals.

On 16 July 2003, the new Secretary of State John Reid, went further in a speech to the New Health Network. He committed to extending patient choice across the country for those waiting more than 6 months from 2004. He also set out how the government would extend choice for all at the point of referral. The secretary of state also expressed a desire to extend choice into services such as chronic diseases, primary care and maternity services.

The following month, the government launched a widespread consultation to explore what patients and the public would want choice to look like. In promoting the consultation, Sir Nigel Crisp, Chief Executive of the NHS, stated that:

'The NHS is growing fast, and will continue to do so over the next few years. As we grow, we have the opportunity to offer people more choice over their care and more involvement in decision making; we can become more responsive to patients, design services better, and tackle inequalities.'

The consultation closed in November. On 9 December 2003, the main themes that had emerged from the 'Choice, Responsiveness and Equity' consultation were published in the strategy document, Building on the best: choice, responsiveness and equity in the NHS

Outcomes of the consultation

The Department of Health made a number of commitments relating to widening the choice agenda:

  • In line with the commitments John Reid had outlined in his July 2003 speech, from August 2004 people waiting more than 6 months for surgery would be offered faster treatment at an alternative hospital.
  • By December 2005, patients requiring surgery would be offered a choice of four or five providers at the point of referral.

The expansion of patient choice was linked to the development of greater equity in the NHS:

'Furthermore, we argue that there is no contradiction between the increase in choice and the development of greater equity in the NHS. In fact we argue that, at the moment, the choice that exists within the NHS serves only relatively few people who can find their way through a difficult system. If we make these choices open to everyone, the ability to find their way through the system will belong not just to a few, but to the many. Overwhelmingly, the many people who joined in our consultation told us they wanted to see that wider choice in real practical terms.'


Milburn A.
Choices for All.
Speech presented to NHS Chief Executives.
2003 Feb 11; London.

Reid J.
Choice Speech to the New Health Network.
2003 Jul 16; London.

Donnelly L.
Radical consultation: what do patients want?
Health Service Journal.
2003; II3(5867): 5.

Department of Health.
Building on the best: Choice, responsiveness and equity in the NHS.
HMSO; 2003.