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Should the NHS budget be ring fenced? No

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4354 (Published 17 August 2010) Cite this as: BMJ 2010;341:c4354
  1. David J Hunter, professor of health policy and management
  1. 1Durham University, Durham, TS17 6BH
  1. d.j.hunter{at}durham.ac.uk

    John Appleby (doi:10.1136/bmj.c4350) argues that the alternative to ring fencing is too painful, but David Hunter believes the focus should be on wider factors contributing to ill health

    On the face of it, ring fencing the NHS budget is a welcome demonstration of the government’s social conscience and determination to avoid a return to the 1980s and 1990s when the service was on its knees, starved of resources. But what may seem like a well intentioned, if populist, act may prove short sighted and self defeating. Far from improving the public’s health, it may have the opposite effect.

    For some right wing commentators, ring fencing the NHS budget is anathema on purely ideological grounds. They have a visceral abhorrence of the NHS and would love to see it squeezed so that a free market in health care could be unleashed. Indeed, this is likely to happen anyway as a result of the government’s plans for the NHS.1 But there are others who, though remaining wedded to the founding principles of the NHS, believe it squanders resources and is not as productive as it should be for the investment it receives—flaws which a protected budget would merely conceal.

    But these …

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