Rationing is now accepted as inevitable by all sides

BMJ 1997; 314 doi: (Published 15 February 1997) Cite this as: BMJ 1997;314:461
  1. Zosia Kmietowciz
  1. London

    Medical opinion leaders and policy makers have admitted that priority setting will form the future framework of clinical practice in Britain's NHS.

    Priority Setting in the NHS is the first document by a working party set up to look at the issue which brings together representatives of the BMA, the Academy of Medical Royal Colleges, the National Association of Health Authorities and Trusts, and the NHS Executive.

    The report calls on health professionals, the public, and the government to accept the need for setting boundaries of medical treatment and to contribute to the discussion on establishing a prioritised health service.

    The working party behind the report says that there is no distinction between terms that have been used to describe the allocation of NHS resources in the past. Rationing, resource allocation, prioritising, and choices all essentially describe the same task—that of making “choices between competing priorities when resources are scarce.”

    The way forward is not to quibble over terminology but to recognise the need to set priorities and develop a consensus on the way forward.

    Bill New, senior research officer at the King's Fund Policy Institute, says that the document is “a watershed in the debate on priority setting.” He said: “It is significant that the authors are admitting that rationing is inevitable.” Mr New said that he believed that it was the first time that the BMA has come down so clearly on the side of rationing.

    But Dr Caroline Marriott, a member of the working party, consultant psychiatrist at Muckamore Abbey Hospital in Antrim, and deputy chairwoman of the BMA Central Consultants and Specialists Committee, denies that the BMA is in any way back tracking on the issue. “We have always acknowledged that there is increasing need in the NHS and no matter what is spent we have to make decisions about service delivery,” she said. “In the past we have done this by waiting lists, but as this has become increasingly unacceptable the working party wants to contribute to the debate on how to get things done.”

    Professor Maurice Lessof, chairman of Lewisham Hospital NHS Trust and a member of the working party, said: “People have talked about increasing efficiency and managing the problem that way. But there is no country in the world that can afford all the high technology treatments that are available. Increasing demand means that there is going to be a gap between what is available and what can be provided.” National priorities need to be established to ensure that the same treatments are available no matter where you live, he added.

    In the document the working party draws on experiences from other countries. New Zealand sets priorities by promoting evidence based guidelines on treatment protocols, while in the Netherlands attempts have been made to develop criteria to exclude certain services from public funding.

    By April the working party hopes to publish a document on more practical aspects of priority setting, after which it intends to hold a national event “to review progress and synthesise ideas.” By late autumn regional events will be held to help managers and clinicians develop local frameworks for priority setting.

    The BMJ, BMA, King's Fund, College of Health, and Rationing Agenda Group will be holding a conference entitled “Rationing in the NHS: Time to get real” on 10 and 11 July at Kensington Town Hall. For further information ring Jane Lewis 0171 383 6605 (email: 106005.2356