An advertising war among hospitals was predicted last night as the Government launched a fresh postcode lottery in the NHS with the introduction of choice for patients.
From today, patients will be able to choose among at least four hospitals, clinics or treatment centres in their area, including private units in some cases, marking what ministers described as the end of the "take it or leave it" NHS.
Hospitals are preparing to launch advertising campaigns to compete for patients, which critics say is a waste of precious NHS resources and will undermine the communal culture of the NHS. Less popular hospitals may be forced to close while successful ones may be overwhelmed in the NHS market.
By 2008, ministers plan to offer patients a choice of any hospital, NHS or private, anywhere in the country that can provide treatment at the NHS tariff.
Paul Miller, chairman of the British Medical Association's consultants committee, said: "An advertising war is inevitable. This is not speculation - the NHS is already holding conferences about marketing for hospitals. Choice for patients is a good thing but spending NHS resources employing marketing people and buying advertising space is probably not where most people want their NHS resources spent. It is different from Marks & Spencer advertising on the high street."
Patricia Hewitt, the Health Secretary, said the introduction of patient choice was one of the most fundamental reforms in the history of the NHS. "Choice matters to patients and the public. In modern society people have more choice over virtually every aspect of their lives. What they are telling us is that they want more choice over their health care, too."
City dwellers in areas where hospitals are concentrated, such as London, will have a choice of up to 10 hospitals in each specialty. The losers will be those in rural areas who, though offered a choice, will be limited to their nearest hospital by `distance and transport difficulties.
Ms Hewitt has said she is "instinctively against" advertising by NHS trusts, but the health department said it would publish guidelines on advertising this year. Ministers believe that choice will drive reform in the NHS by forcing poorly performing hospitals to raise their game. NHS waiting lists in London only started to fall dramatically when pilot schemes for patient choice were introduced, Ms Hewitt said. Critics claimed that what people wanted was a good local hospital rather than more choice, she added. "Of course that is what people want but this will help achieve a good local hospital."
Ms Hewitt admitted that popular hospitals would come under extra pressure: "Popular hospitals are by definition going to have more patients but that doesn't mean they are going to bust their waiting list targets. There will be opportunities for them to expand."
An airline booking system for hospital appointments, allowing patients to choose and book an appointment for their hospital treatment during the consultation with the GP, was due to have been introduced to coincide with the launch of patient choice but is a year behind schedule.
Ministers said a quarter of GPs were now using the computerised system.
Lord Warner, the minister for NHS delivery, rejected claims that overworked GPs would not have the time to help patients choose from among up to 10 hospitals. "GPs see one person a day on average where there is a question of their having elective surgery so there will be time, we believe, for them to help those patients make their choices."