BMJ  2006;333 (1 July), doi:10.1136/bmj.333.7557.0-f

Editor's choice

Say no to the market

How representative is the BMA's annual representative meeting? If it is representative, there's an astonishing consensus among UK doctors about the health service we want. Last week's meeting in Belfast stopped short of affiliating with "Keep our NHS public"—a pressure group founded last year because of "an urgent need to defend the NHS" (see news on bmj.com). But there was no mistaking the passion among BMA representatives for a publicly funded, freely available national health service.

A few people spoke against funding through general taxation, pointing to the European social insurance model, which delivers higher quality care, though at higher cost. And a few spoke against care being free at the point of access, suggesting that charges would moderate demand, enhance patient responsibility, and help bridge the funding gap. But when it came to a vote, support for the founding principles of the NHS was overwhelming (p 9).

Equally overwhelming was rejection of US-style health care. "The very last thing the UK should do is go for the American model," said the Chairman of Council, Jim Johnson. After voting in support of the NHS's values, the meeting agreed that these could not be delivered through private corporations.

There's enough bad news about America's health system to justify this wholesale rejection. On top of the familiar spectacle of inefficient and fragmented care, spiralling costs, and growing inequities of access, there's now evidence that quality of care is patchy and worse overall than in other developed nations (see http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.509v3). There's an irony in the UK government being in thrall to US-style health care, while US commentators now hold as their exemplar the Veterans Health Administration—America's nearest thing to the NHS.

But American health care is an aberration. No other developed country has adopted such a system. Is this really what the UK government has in its sights? The problem is we don't know and nor it seems do they. Two weeks ago a report from the King's Fund called on the government to come clean about its plans to establish a market in health care in order to avoid a damaging muddle (BMJ 2006;332: 1353[Free Full Text]).

Perhaps we'll get more clarity after next week's health summit, convened by the battle weary health secretary and involving among others the now embattled BMA leadership (following last week's vote of no confidence in its handling of the NHS reforms, p 9). The mandate from BMA representatives is clear. They want a vision for health care that does not involve the market, uses ethical rationing based on clinical need, has commissioning driven by quality not profit, is patient not shareholder centred, and is clinician led. For this to work we need far better ways to judge performance and quality, which will rely on having decent information on outcomes of care. If these are not your views, shout now.