Headlines: November 3rd, 1997

The King’s Fund and the British Medical Journal have opened the debate on health care rationing in advance of the White Paper setting out the Government’s proposals.The ideas and principles of fair rationing are described in their new publication – Rationing: Talk and Action in Health Care. It contains articles from leading rationing experts and it destroys the myth that there is no rationing in the NHS. Robert Maxwell, chief executive of the King’s Fund said: “Rationing has always taken place in the NHS, but it has been consistently denied by the Government. We hope that the White Paper to be published shortly will set out their intentions.

Dr Richard Smith, editor of the BMJ said: “It looks like the phoney war on rationing is ending. For years most of those working in the NHS have known that rationing happens every day. Managers know it, the media know it and the Government knows it. But the Government hasn’t accepted it, meaning that the real work of rationing fairly, effectively and efficiently hasn’t been able to start. Now the chief executive of the NHS is talking about rationing and we may be able to set to work.”

The writers explore how the principles of rationing should be decided and particularly who should be involved. General public participation is seen as essential, but a severe constraint is the lack of public awareness of information about the health service. Unless the public are made more aware of what is going on within the service it will be difficult to get a consensus in drawing up the principles. In recent surveys mental health, community care and long stay are regarded by the public as less important than high technology surgery and screening for breast cancer. Health professionals take a contrary view.

The information constraint should be seen against the background of the move towards openness which is part of the ‘open government‘ policy. As Authorities and Trusts disclose more of their decisions and how they were reached, public awareness of the issues will increase. What we are seeing now in the rationing debate is the opening of the health service to increasing public scrutiny and greater consumer influence.