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Dear Mr Dobson …

BMJ 1997; 315 doi: (Published 19 July 1997) Cite this as: BMJ 1997;315:143
  1. Ian Kennedy, head and dean of the school of law,
  2. George Levvy, chief executive,
  3. Sandy Macara, chairman,
  4. Robert Maxwell, chief executive,
  5. Alan Maynard, department of health sciences and clinical evaluation,
  6. Richard Smith, editor,
  7. Ron Zimmern, director of public health
  1. King's College
  2. Motor Neurone Disease Association
  3. BMA Council
  4. King's Fund
  5. University of York
  6. BMJ
  7. Cambridge and Huntingdon Health Authority

    Delegates attending a conference in London last week entitled Rationing in the NHS: Time to Get Real called on the British government to face up to its responsibilities. In an open debate the multidisciplinary assembly of 250 doctors, patients, and healthcare managers voted overwhelmingly in favour of the motion “the government has an obligation take a lead in rationing.” The conference then sent this open letter to the secretary of state for health

    Dear Mr Dobson,

    At a conference in London last week about 250 people from all parts of the National Health Service agreed that not all health services can be provided to everybody who might benefit from them. This will remain true even with more generous funding, greater efficiency, and lower management costs.

    Rationing has always existed in all health services and always will. Many health interventions produce in some patients small benefit at enormous cost–for example, treating high cholesterol in a young woman with no other risk factors for heart disease or offering magnetic resonance imaging to a young …

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