The government’s drive to extend patient choice to a range of services and providers will only benefit those who can express their healthcare preferences. For patients who can’t, and that includes some people with learning disabilities, Crispin Hebron warns the system won’t be so equitable

Choice is increasingly taking centre stage of the modernisation agenda within the NHS. The contradictions and complexities inherent in such an approach become apparent when considered alongside ideas of inclusion, social justice and equity, which are presented as the foundation of New Labour’s thinking. These tensions are highlighted by the potential impact of such policy developments on people with learning disabilities who experience high levels of vulnerability and exclusion in society and high levels of unmet health need (Barr et al 1999, Wilson and Haire 1990).