Choice is a leitmotif of neoliberalism. It is the choice imperative that drives key performance indicators across the public sector, whether it is education, health care or social care. The rationale is that â€˜the publicâ€™ need to know which service providers are performing well (i.e. meeting their targets) and which service providers are performing badly (i.e. not meeting their targets). Based on this information, â€˜the publicâ€™ are then in a position to choose which service provider they utilise...thatâ€™s the theory at leastâ€¦ Choice of service is often linked to other lifestyle choices, where in the ironic words of Renton (from Trainspotting) we are exhorted to choose good health, choose a job, choose life. But this choice is more than it appears to be, it carries a whole host of incumbent consequences that are not an explicit feature of the rhetoric. Take the NHS as an example. Choice is also the leitmotif of the contemporary NHS, with changes to service provision branded under the â€˜choice agendaâ€™. An expedient example is the NHS website. Here the public are informed that it is â€œyour health your choicesâ€ (http://www.nhs.uk/). By making it â€˜our choiceâ€™, it also made to be an individual property rather than a feature of our society. Within this rubric, the situation emerges whereby our health is marked out by our choices, with the implicit assumption that we are free to make the 'right' health choices. Whereas citizenship is accompanied by discourses of rights and responsibilities, consumerism is accompanied by discourses of entitlements and expectations. This alteration functions to shift the locus of responsibility away from the state and onto the consumer, who in turn push it onto the professions providing the services. Within this shift health comes to be described in an individual language of lifestyle choice.
The medical patient constrained by structural factors impacting directly upon their health status, is now contradicted by the individual as sovereign consumer with the freedom to make lifestyle choices. As I see it, the rhetoric has changed, but the impediments have not. The idea that we have the responsibility to choose good health is perhaps best regarded as a rhetorical twist that makes health targets much easier to meet. With the healthy consumer, the health performance targets become properties of an individual's lifestyle rather than being seen as reflecting wider social inequalities