The centrality of patient choice in the recent political rhetoric of both New Labour and the Conservative Party has prompted a renewed interest in the shift towards a more consumerist conception of health care in the UK. Accordingly, this article reports on early findings from a project in the ESRC/AHRB Cultures of Consumption Programme, exploring how the ‘consumer’ is constituted in narratives of health reform, and the ways in which policy documents present a particular image of the consumer as a rationale for institutional and cultural change. The article then goes on to look at the ways in which service delivery organisations have responded to New Labour's consumerist imperative. Drawing upon a series of interviews with senior health care managers in two case study locations, the article highlights ways in which choice, responsibility and empowerment have become critical points at which a consumerist orientation is articulated with established professional cultures, and how health organisations have experienced – and attempted to resolve – the tensions that result.