Patient choice in the NHS: what is the effect of choice policies on patients and relationships in health economies?

Policy-makers are increasingly advocating market-based reforms to increase choices for service users and therefore to drive improvement through competition. This article assesses this approach in a hospital trust where there is plenty of scope for patients to choose providers and so for reforms based on a market logic to work. The market had very little impact on the hospital's activities, but demands from the Department of Health and the strategic health authority for the hospital to become more market-oriented were creating the potential for significant dysfunctional consequences.