Introduction

This extract from a speech made by Tony Blair in the summer of 2004 captures something of the centrality of the idea of citizens as consumers to New Labour's approach to public service reform. This conception of citizens as consumers registers how significant the ‘choice’ issue has become for current debates about the future of healthcare – and public services more generally. Its importance in current policy debates is further illustrated when we consider that, despite it being New Labour's ‘meta-value’ (Bunting, 2003), the Conservative Party has also claimed choice as their ‘big idea’. Unsurprisingly, this focus upon choice/consumerism in policy debate raises a whole range of issues. These include different proposals for means of institutionalising choice; different views about the problems of choice; arguments about whether choice can, or should, be the main coordinating mechanism for health and other services; implications about the relationships between resources and service provision; different views of the relationships between the public, patients, professionals and political representatives; and differing conceptions of the relationship between choice and inequality (see, for example, Needham, 2003; Leadbeater, 2004; NCC, 2004). In this chapter, we want to take up two clusters of issues arising from this consumerist focus:

• 1. the relationship between consumerism and inequalities; and

• 2. the unstable consequences of consumerism in the reform of public Services.

We end with some reflections on the implications of these two issues for the politics and policies of choice in public services.