At the moment the only choice for patients if they want a short wait for treatment is of opting out of the NHS

Alan Milburn Health Secretary

Under a pilot scheme due to be up and running across London by July 2002, patients who have waited more than six months will be contacted and offered a choice of where to be treated.

Under the scheme patients may also be treated in the private sector, with care funded by the NHS. Some may also be sent to Europe.

Mr Milburn is due to tell MPs on Thursday how the money will be divided up among England's health authorities and what share of the cash different hospitals will receive.

The health secretary denied the plan was an admission that the public health care system had failed, saying it reflected the years of under funding the service had suffered.

'Terrible dilemma'

"What we need to do is turn this large scale, if you like old-style nationalised industry, that has been run from the top down into an organisation that is much more diverse and decentralised and much more responsive to patients," he told BBC Radio 4's Today programme.

"At the moment the only choice for patients if they want a short wait for treatment is of opting out of the NHS, so patients are in this terrible dilemma of having to wait for treatment or pay for treatment."

Shadow health secretary Dr Liam Fox said it was a "total distortion of clinical priorities".

He said: "It is nothing to do with the patients who are the most urgent cases being treated.

"It is to do with the political urgency of ministers who are simply more worried about saving their skins than they are about worrying about patients."

It's important that patients are given choice, but that patients are given expectations that can be fulfilled

Mike Stone Patients Association

It is hoped the scheme will eventually be available to patients as soon as they are referred for treatment.

Patient groups have said more choice is important, but warned the government must deliver on its promises.

Questions have also been raised about the cost of such a scheme, and whether patients would be able to make an informed choice about where they wanted to be treated.

Mike Stone, chief executive of the Patients Association, said the plan could lead to patients expecting to be able to go to their GP "tomorrow" and bypass waits by being sent to France for their operation

Patient expectation

He also questioned who would be responsible for post operative care and how relatives would get to visit their loved ones, which was part of the recovery process for patients.

He said: "It's great for the Department of Health to come out and say things like this, but it raises patient expectations.

"It's important that patients are given choice, but that patients are given expectations that can be fulfilled."

He said the idea of piloting the scheme may not translate for patients, who may expect to be able to choose their hospitals where-ever they may live.

Informed choice

Mr Stone said the NHS should get away from the "bizarre situation" where patients have to be treated at their local hospital and an end to "postcode rationing" of services.

Bonn-based Dr Axel Hollander said NHS patients coming to Germany for treatment would expect to stay in hospital longer than usual to cover the need for after care and any risk of complications.

A spokesman for the independent health think-tank the King's Fund said in Sweden, where a similar scheme exists, very few people took it up.

He said: "Will patients have enough information to have an informed choice? Will they get information about success rates in different hospitals - and will that be interpreted for them?"

He said there was also a question over whether the NHS would fund travel and accommodation costs for the relatives of patients who choose to be treated a long way from home.

"Will it be easier for people who are more articulate and more wealthy to take up the offer?" he asked.