BMJ 1995;311:264 (22 July)

Letters

Rationing

Local debate is needed

EDITOR,--Richard Smith is right to call for the reopening of the debate on rationing,1 but he misses the point in asserting that "Britain has not had the ... prolonged debate on rationing that is needed" because the key level at which this debate is needed is the local one. In the past, decisions on rationing in the NHS have been influenced by institutional factors,2 but now commissioners must ration. It is an uphill struggle for two reasons.

Firstly, "the NHS is drowning in organisational tasks while the real work of planning and needs assessment is disappearing in the quicksand of the internal market."3 This is hardly the background against which to develop a continuous local debate, which should promote open and informed argument and draw on a variety of perspectives. Secondly, provision of health care is complex, and relying on economic rationality to solve problems opens . . . [Full text of this article]


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Relevant Article

Rationing intensive care
J Bion
BMJ 1995 310: 682-683. [Extract] [Full Text]

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