De gezondheid en het onderwijs zijn de belangrijkste gebieden waar de politici keus als beste manier zien om de diensten te verbeteren. Kiezend waar en welke behandeling hebben en welke school om te sturen uw kinderen naar beleid zijn dat zowel de Arbeid als de Conservatieve partijen nastreven. Het overzicht Darzi van dit jaar gemaakt tot patiënten' herstelt de nadruk van verandering, voorstellend dat de patiënten' meningen over de kwaliteit van zorg een invloed zouden moeten hebben bij de toekomstige financiering, met bonussen voor die GPs en ziekenhuizen die de beste diensten verlenen. Voorts zouden de resultaten van geduldige tevredenheid moeten worden gepubliceerd creërend een vorm van NHS liga lijst die patiënten toestaat om te kiezen bij welk GP of ziekenhuis dat zij hebben gewenst om hun behandeling te ontvangen.

De ouders worden voortdurend verteld dat door welke school te kunnen verkiezen om te sturen hun kinderen naar zij een betere overeenkomst van staatsonderwijs krijgen. De ministers van de overheid eulogise keus als beste manier om aan de onderwijsbehoeften van een kind aan de school tegemoet te komen die het best wordt geplaatst om hen te verzorgen.

De keus zoals die door deze overheid wordt voorgeschreven, echter, leidt tot centralisatie, vernietiging van gemeenschappen, privatisering en marginalisation van slechtst van het proces. Hun erfenis van keus zal minder keus zijn.

De poliklinieken zijn een perfect voorbeeld van dit. De patiënten worden verteld dat deze super-chirurgie zal leiden tot meer keus maar één zeer belangrijke keus zal worden verwijderd: de keus om naar het uw communautair ziekenhuis te gaan of GP. De bejaarde patiënten, die vaak naar medische raad moeten streven, zien=zullen= hun verhoudingen met hun vernietigde arts en zullen wordt gedwongen om onpraktische afstanden te reizen.

NHS de liga lijsten, terwijl het schijnen om geduldige keus te verhogen, zijn in werkelijkheid enkel een andere manier om meer doelstellingen op te leggen. Voorts als de patiënten hen gebruiken om besluiten te nemen waarover het ziekenhuis om te gaan zij zal vinden dat de keus wordt verwijderd. 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 clamour 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.