Choice - not all it's made out to be

Buzzwords abound in the rhetoric of politicians and nevermore so than when the talk is of public sector reform. Of the current phrases spewing forth ‘choice’ and ‘empowerment’ are two of the favourites but whose choice and whose empowerment? And while MP’s try to frame these words as synonyms of ‘public benefit’, is choice always a good thing?

Health and education are the main areas where politicians see choice as the best way of improving services. Choosing where and what treatment to have and which school to send your children to are policies which both the Labour and Conservative parties are pursuing. This year’s Darzi review made patients’ rights the focus of change, proposing that patients’ views on the quality of care should have an impact on future funding, with bonuses for those GPs and hospitals providing the best services. Furthermore, the results of patient satisfaction should be published creating a form of NHS league table allowing patients to choose at which GP or hospital they wish to receive their treatment.

Parents are continually told that by being able to choose which school to send their children to they are getting a better deal from state education. Government ministers eulogise choice as the best way to match a child’s educational needs to the school which is best placed to cater for them.

Choice as prescribed by this government, however, leads to centralisation, destruction of communities, privatisation and the marginalisation of the poorest from the process. Their legacy of choice will be less choice.

Polyclinics are a perfect example of this. Patients are told that these super-surgeries will lead to more choice but one key choice will be removed: the choice to go to your community hospital or GP. Elderly patients, who frequently need to seek medical advice, will see their relationships with their doctor destroyed and will be forced to travel impractical distances.

NHS league tables, while appearing to increase patient choice, are in reality just another way of imposing more targets. Moreover, if patients do utilize them to make decisions about which hospital to go to they will find that choice is removed. A hospital which scores poorly in the table will receive less funding, therefore their results will get worse and fewer patients will choose them. As this spiral continues services will have to be closed down as they will no longer be efficient and then you no longer have a choice.

Choices can also be confusing, stressful and in the end you can always make the wrong one. When it comes to medicine my knowledge is possibly not as comprehensive as that of a qualified and experienced practitioner. I would, therefore, rather know that all hospitals and surgeries are clean and friendly and then allow my GP to refer me to the nearest one where I could receive the required treatment.

The government's promise to give every parent a choice of secondary school for their child was proved a myth again this year with figures showing the number of pupils getting their first choice of school has dropped. As parents understandably clamor to get their children in to schools high up the league tables the idea of going to your local school is becoming a nostalgic notion, with over half of children not going to their nearest school.

Commuting to school is detrimental to community development and the environment. Worse still any benefits of the current policy are going to the wealthiest. A report by Bristol University found that disadvantaged families miss out in the current system and even in the same postcodes poorer families end up at the lower-performing schools. Expanding the better performing schools may not be possible as “giving popular schools the freedom to expand does not mean they will do so. To the extent that a school's position in the league tables depends on the attainment of its intake, schools may be unwilling to increase and potentially to dilute the quality of their student body,” said Professor Burgess.

Whilst ‘good’ schools cream off the best pupils the rest are left with lower league table results and less people ‘choosing’ to go there. Some of the best teachers may leave and in worse case scenarios the school maybe closed. As with hospitals the choice is then removed. Furthermore, expanding the best schools and shrinking or closing the rest as suggested will result in huge institutions where education suffers. American researchers are leading the way in analysing the impacts of school size. Craig Howley, of Ohio University, and Robert Bickel, of Marshall University, looked at whether smaller schools could reduce the negative effects of poverty on student achievement. They found that the correlation between poverty and low achievement was ten times stronger in larger schools than in smaller ones. “Everyone knows that there is a strong association between social class and achievement and that this association works very much to the disadvantage of economically disadvantaged students,” Bickel told Education World. “The California research, however, had the virtue of demonstrating that this disadvantage was exaggerated as school size increased.”

One in seven pupils in England are now in a secondary school with over 1,500 students and the number of pupils in schools of over 2,000 has doubled since 1997. Promoting choice is driving these figures ever higher.

If you thought a change of government would bring about a change of direction then, like in most areas, the differences between Labour and the Conservatives are negligible. In a letter this week to local residents, Philip Dunne, Conservative MP for South Shropshire wrote: ‘We believe that the best way to enhance the power of patients is through choice. We will allow patients to choose, in consultation with their GP, where they get their secondary care. And we will ensure that money follows the patient so that hospitals and clinics and other care providers are paid according to the results they deliver for that patient.’ Once again, it seems, Labour equals Conservative and the public is left without an alternative.

When ministers speak of choice what they really mean is installing the practice of privatised competition in the public sector. Not even the most ardent free-market Tory would openly pursue a fully privatised health or education service; it would be electoral suicide. All politicians know this so instead they are doing it under the radar masked by the promise of choice.

Genuine, useful choice and universal empowerment are great things which should be strived for but do not confuse them with current government policy. Next time you get excited by the prospect of politicians offering you a choice think again as it’s not always a good thing.