Letters

The real ethics of rationing

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7117.1231 (Published 08 November 1997) Cite this as: BMJ 1997;315:1231

Purchasers, not surgeons, control waiting lists

  1. J R E Hamilton, Consultant cardiac surgeona
  1. a Freeman Hospital, Newcastle upon Tyne NE7 7DN
  2. b Royal Hospitals NHS Trust, London E1 1BB
  3. c 4 West Farm Close, Ogmore by Sea, Bridgend CF32 0PT

    Editor—I applaud the BMJ's efforts to bring the important issue of rationing to the fore, but I cannot allow one aspect of Light's contribution to go without challenge.1 Under the heading “parasitic privatisation” he says, “to top it off, the surgeons control the waiting lists” (to encourage patients into the private sector). I despair that someone of his academic stature should show such a lack of understanding of the purchaser-provider split that we have had in the NHS for the past six years. In the vast majority of cases we as surgeons have a contract with purchasers that places an upper limit on the number of patients on whom we can operate. Thus surgeons have no control over the number of patients having surgery and therefore, by definition, over the waiting list. The role of the surgeon is to prioritise, on clinical grounds, within the contracted number.

    If surgeons are to operate on more patients then purchasers must contract for more operations. The onus to reduce waiting time, and therefore encourage patients not to use the private sector, lies solely with the purchasers.

    References

    1. 1.

    Doctors should not be penalised for doing private work in spare time

    1. Francis Chinegwundoh, Consultant urologistb
    1. a Freeman Hospital, Newcastle upon Tyne NE7 7DN
    2. b Royal Hospitals NHS Trust, London E1 1BB
    3. c 4 West Farm Close, Ogmore by Sea, Bridgend CF32 0PT

      Editor—Parts of Light's article on the ethics …

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