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

Later on Thursday Prime Minister Tony Blair will try to drive home his message of "radical reform" for the health service at a news conference.

Mr Blair is expected to map out some of the scope of the shake-up plans and his preference for funding to come via taxpayers rather than health insurance.

His official spokesman said: "While we believe in a monopoly funding provider, on the supply side the government is committed to radical reform."

Private options

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.

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

Mr Milburn told MPs that choice would first be available for heart operations but later rolled out to cover other conditions.

"It will for the first time be the patient's choice and that choice will no longer be between waiting longer for treatment and paying for treatment."

The scheme is only for England, prompting opposition parties in the Welsh Assembly to call for similar plans in Wales.

Mr Milburn's announcement follows news that a private hospital is to act exclusively as an "express surgery centre" for routine NHS operations in a move that angered trade unions

Ministers want to cut waiting times

All England's health authorities would see their budgets boosted by 9.3% in the next financial year, Mr Milburn told the Commons.

The health secretary says the plan is part of a wider reform programme.

"Our aim must be to create a more decentralised, more diverse, more responsive health service capable of offering patients better services and greater choice."

Mr Milburn expects maximum waiting times to fall from 18 months to 12 months by April 2003, when he says nine out of 10 patients should be able to see a GP within 48 hours.

'Saving ministers' skins'

Shadow health secretary Liam Fox welcomed the decision to restrict the plan to heart patients but said that differed from the "spin" put out by ministers ahead of the announcement.

Dr Fox told the Commons: "It will be very clearly seen to be more about saving minister's skins rather than about saving patients."

Milburn signals change ahead

For the Liberal Democrats, health spokesman Evan Harris said maximum waiting times could cause "clinical distortions" where politics came first.

Dr Harris argued the value of more choice for patients was limited when some were too sick to travel to get quality treatment.

Critics of the plans say they dodge the real issue of the shortage of NHS doctors, nurses and beds.

Mr Milburn instead hailed progress on attracting new staff as he extended the scope of allowances to help healthcare workers meet the high cost of living in south-east England.

Patient groups have said more choice is important, but warned that 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.

Patient expectation

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.

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.

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.