Mary Dejevsky: Never mind the choice, just give me the quality

How many hours must we spend studying self-help books to find the gynaecologist of our choice?

Recently arrived on my desk is a stylish yellow and white brochure that looks for all the world like a company annual report or the sort of privatisation propaganda that "Sid" tried to seduce us with many moons ago. It is, in fact, the Liberal Democrats' latest policy document, which argues for local funding and provision of such basic services as education and health.

Now, this is an enticing idea that maybe has a future, once it has been tried out somewhere small and manageable, like New Zealand or Sweden. Pare out the old, big-L, Liberal emphasis on everything local, however, and the language could equally be New Labour or New (now old, ie Thatcherite) Tory.

Conference season exposes just how monolingual our once-distinct parties have become. What every political party is trying to offer us these days is – as the title of the Lib Dems' brochure has it – Quality, Innovation, Choice, which is presumably what their market research tells them we want. Sometime they are going to need our votes, after all.

Well, I am all for quality and innovation, and I am quite keen on receiving good value for my tax money (another favourite political marketing pitch). But I am less and less sure about choice.

Singly or in compounds (consumer choice, school choice, hospital choice, you've heard them all), Choice fosters all kinds of good feelings. To have a choice (or rather to be promised one in the future) makes us think well of ourselves and of those who are so flatteringly treating us as citizens rather than subjects.

"Choice", and its constant companion "empowerment", are the God, mother and apple-pie of contemporary democracy. The assumption is that all we well-educated, technically savvy Britons want nothing so much as to manage our own destiny. Rather than ordering us around, today's politicians aspire to be "facilitators"; they see their job as providing the "choices" – and ours to choose.

Which is where the deception begins. There are some things in life where choice narrows to vanishing point. Go into any GP's waiting-room in this country and I challenge you to find more than one or two people, if that, who would welcome more choice. They might want a more pleasant waiting room and a less hassled doctor, but that is "quality", not "choice".

Which clinic they are registered at depends largely on the proximity of the surgery to where they live. Which GP they see depends who is on duty on the day they fall ill. If you need urgent hospital treatment, you are taken to the nearest casualty department, or the one that has a free bed (not necessarily the same thing).

The same non-choice applies to schools. With an infinite number of good schools, good teachers and an ever-expanding number of places, parents might enjoy more of a genuine choice. But that is Utopia. The real extent of "school choice" in most of the developed world is the ability to afford a house in a good catchment area in good time. The realistic alternatives are to kick up an almighty fuss, or to pay.

Even where something akin to real choice does exist, we are mostly not qualified to exercise it. You might scan hospital performance tables to find the department or the surgeon with the best record, but how much do all these league tables really tell us? That the surgeons are the most expert, or that they have picked the simplest cases? How many hours must we spend studying the Yellow Pages or self-help books or the internet to find the dermatologist or gynaecologist of our "choice"? Maybe it was unenterprising, but relying on the recommendation of the professionals (our GP) was not such a bad idea after all.

Deregulation of the telephone system and utilities have brought undoubted benefits. We can buy telephone handsets at the supermarket and plug them into the wall; we can (mostly) have a phone line installed within the week, and a high-speed line, too, should we "choose" (ie pay).

But when the brochures drop on the mat, boasting the merits of one gas company versus another, one phone plan versus another, you have to calculate whether the time you spend comparing the small print is worth the – usually negligible – saving.

In the United States you can spend most of your waking hours calculating differential "plans" or switching phone and utilities companies (or being switched) to save a few cents, and we are going the same way here. Yet I struggle to believe that our "new", "competitive" companies necessarily provide a better service than a toughly regulated monopoly. All that money currently spent on glossy advertising on separate managements could then be spent on improving the service and cutting the price.

The fact is that "choice", as governments offer it, is a mirage: the closer you get to it, the less real and substantial it becomes. It is the ultimate political cop-out. "Over to you, the people," our Lib-Lab-Tory politicians say, "you are old enough and bright enough to make your own 'choices'." But we have neither the time nor the information nor the power to do the job properly. The big "choices", the unpopular trade-offs, remain theirs. This is what we elected them for.

m.dejevsky@independent.co.uk