Accounting Forum 30 (2006) 359–376 Delivering patient choice in English acute hospital trusts Mike Dent a,∗ , Colin Haslam b a Faculty of Health and Sciences, Staffordshire University, Staffordshire, United Kingdom b University of Hertfordshire, Hertfordshire, United Kingdom Abstract The role of the patient within the NHS has changed from supplicant to consumer to active participant. A demand-side patient-led approach is combining quasi-consumerism and participative democracy to inform and facilitate patient choice. On the supply-side funding and incentives coupled to reform and performance will deliver additional hospital capacity and patient choice. This paper argues from both a demand and supply-side perspective that there is a large gap between the rhetoric and reality of delivering patient choice in acute hospitals. © 2006 Elsevier Ltd. All rights reserved. Keywords: NHS reform; Patient choice; Public management; Acute hospitals The NHS now has the capacity and the capability to move on from being an organ- isation which simply delivers services to people to being one which is totally patient led—responding to their needs and wishes. (Department of Health, 2005, p. 5) 1. Introduction Patient choice within the UK National Health Service (NHS) is a hybrid, a combination of quasi-consumerism and participative democracy. While the new arrangements could become the basis of a self-sustaining and beneficent system (Luhmann, 1995; Morgan, 1997), the argument here is that that these reforms designed to bring greater choice to the patient are technically and practically flawed. It is not our intention to argue for or against patient choice because on balance we are ‘for’ it in principle but we have reservations in relation to what ‘choice’ means within the NHS at the present time. ∗ Corresponding author. E-mail address: Mike.Dent@staffs.ac.uk (M. Dent). 0155-9982/$ – see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.accfor.2006.08.004