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The public should be warned that rationing of health care is inevitable, doctors said at their annual representatives' meeting in Torquay this week. The doctors also agreed that members of the public should be given explicit advice on which services are available on the NHS so that they can make provision for treatments that fall outside the health service.
In its paper on an alternative strategy for the future of the NHS, published in May (BMJ 2007;334:969 doi: 10.1136/bmj.39210.522188.4E), the BMA raised the possibility that “it may be necessary to ration some services if society is not prepared to pay higher taxes.”
Alex Smallwood, from the BMA's Junior Doctors Committee, told the meeting, “Rationing has become a necessary evil. It is no longer possible to provide all the latest treatments without detriment to others. But we need to formalise it. We need a way out that is fair and equitable.”
Doctors called on the government to be honest about what the NHS could provide. Where rationing was necessary, they said, it should be explicit, publicised, and based on evidence. They said that any rationing should be based on clinical need and clinical effectiveness.
At the moment patients do not know what treatment they are entitled to. “There is complete confusion,” said Dr Smallwood.
John O'Driscoll, from Worcestershire, said, “It is the dishonesty I cannot stand. You can either provide a service or you cannot. No more obfuscation.” He said many people would be prepared to pay £20000 ($40000; €30000) for a heart operation, but they need to know about such costs in advance so that they can plan, perhaps cancelling plans to buy a new car and instead saving the money for an operation should they need one.
Hamish Brown, from Birmingham, speaking against the motion, questioned how rationing could be introduced where there are no services. He gave the example of patients who had received trastuzumab (Herceptin) for six years at a cost of £20000 a year, yet provision of palliative care in the area was dismal, with no lymphoedema service.
“Don't let the BMA become seen as the people who introduced rationing,” he told representatives.
Steven Watkins, a member of the BMA Council, said, “There are some areas of health care where rationing is needed. But the NHS will only meet these needs if it is clear that NHS money is used to help people and that it is not ethical to use it on over-expensive and over-sophisticated treatments and it is not ethical to use it on ministerial whims.”
Representatives also backed the BMA's vision of an NHS run by an independent board, removed from direct government control and free of political interference. They agreed that the board's membership should comprise patients as well as representatives of the public and the medical and other health professions and that members should be appointed through a transparent recruitment process. A final report on the BMA's strategy will be published in September.