Health Warning

"Fear or distress" should not be caused "without good reason". This less-than-reassuring reassurance is part of a code, published this week, that allows NHS-funded hospitals to advertise. Even without the government health warning, it should be obvious that marketing health care is rife with risks.

One obvious danger is of squandering NHS resources on public relations, resources that should be used to treat the sick. The code says expenditure must be appropriate, but if promotions give rise to tit-for-tat publicity wars, the waste could creep up over time. Another worry is that income-hungry hospitals will encourage patients to demand treatments they do not need. The line in the code to guard against this does not seem adequate, being borrowed from general advertising rules restricting the encouragement of the "excessive use of products". The border between medical needs and medical wants may be fuzzy, but policing it is essential to the sustainability of publicly funded health care. One of the reasons for the ruinous expense of the American system is that firms have a vested interest in encouraging patients to seek ever more treatment.

The labor government, of course, is not proposing moving to the US system - it remains committed to an NHS whose real budget it has doubled. So why, exactly, is it backing hospital advertising? The argument is that it will complement choice. That policy is meant to step up a gear on April 1 when patients get the right to be treated at any center in the country meeting national standards and costs. But ministers worry that choice is not taking off as hoped. Long waiting lists at the local hospital make people more likely to seek to go elsewhere. But the longest waits have been shortened, and now patient surveys suggest awareness of choice is flat, or even falling. Advertising may turn that round by enticing people to go further afield.

The logic here is awry. If shorter waits mean people are happy to go locally then that is a triumph, not a cause for concern. Choice may have a role in raising standards, but it is not an end in itself, though Tony Blair used to mistake it for one. Gordon Brown answered him in speeches that argued - with hospital care in particular - that consumers could never safely be sovereign because of their dependence on professional expertise. Hospital advertising risks exploiting that dependence. Mr Brown should have the courage of his convictions and make plain that health care is not just another market. He shrinks from doing so because he is terrified that he is coming to be seen as being less bold than Blair. The unwise proposal for NHS marketing thus reflects problems that the prime minister is having in marketing himself.