A RADICAL shake-up of the NHS designed to offer greater patient choice comes into force in England today.

Patients waiting for non-emergency operations will now be able to choose from at least four local NHS or private hospitals or clinics.

But health unions warn competition could lead to unpopular hospitals closing, while waiting lists soar at the most popular hospitals.

Health Secretary Patricia Hewitt insisted yesterday that the change would raise standards.

She said: "In our modern society, people have more and more choice and control over every aspect of their lives.

"They are telling us they want more choice over their healthcare. Choice is now a reality in the NHS. Patients have new rights over their own healthcare.

"These rights will allow patients to choose services which best meet their individual needs and preferences."

However, health unions including the Royal College of Nursing (RCN) said that, while they backed the principle of choice, the reforms could have the opposite effect.

Alison Kitson, director of nursing at the RCN, said: "There is a real danger that creating a market within the NHS could effectively erode choice for patients as the most popular hospitals become overwhelmed, while the least popular sit empty and may eventually face closure.

"Fewer hospitals mean less choice for patients - and it is the most vulnerable members of society, such as the elderly, who will suffer the most if they cannot access hospital services on their doorstep, leaving them with no real choice at all."

The Government said that pilot schemes suggest that hospitals will become more responsive to issues which matter to patients, such as the speed of treatment, quality of food and being treated with respect.

Ms Hewitt said: "People want a good local hospital, offering good safe care.

"Of course that is what people want. But choice will give them more chance of getting that kind of hospital.

"It will get the less well-performing hospitals to raise their game because they will see they will be falling behind in attracting patients compared to other hospitals."

Ms Hewitt accepted that popular hospitals were going to have more patients, but that should not mean that waiting times passed the six-month target.

Patients about to undergo elective surgery will receive information booklets about their local hospitals, with details such as star ratings, waiting times, rates of the MRSA superbug and cleanliness, to help them decide.

The Government's patients tsar, Harry Cayton, described the change as a "really exciting moment". He added: "This is going to be a real revolution in the way that we as patients think about the health service and the choices that we make in the health service."

The British Heart Foundation (BHF) called for choice in other areas of the NHS - not only for elective surgery.

Shai Davies, head of nurse services, said: "We fund more than 200 BHF Heart Nurses who give specialist care to heart patients, but there simply aren't enough to help everyone who needs them."

Liberal Democrat health spokesman Steve Webb said the move would benefit the rich and well-informed.

He said: "People want more control over their care, but the Government's obsession with markets will mean the least well-advised patients could well end up with inferior care."

By 2008, ministers promise that patients will be able to choose from any hospital or provider anywhere in the country which meets NHS standards at NHS prices.

A White Paper explaining how wider choice can be achieved is expected to be published later this month