Rationing 'only option' for NHS

The document will reopen the treatment debate

The only way to secure the future of the NHS is to make more treatments available only privately, top doctors and nurses have conceded.

A document compiled by representatives of the British Medical Association, Royal College of Nursing, patients, private health providers and the pharmaceutical industry points to increased rationing as the only way forward.

Prior to the year-long review, the BMA had flirted with the idea of patient charges as a means of raising money for the health service.

But now it says that this idea is dead, alongside every other option for providing a more comprehensive service.

Universal service

The controversial document is likely to provoke fierce debate, particularly to decide which treatments fall into the "can't do" pile.

BMA chairman Dr Ian Bogle said patients should be turning increasingly to the private sector to deal with non-urgent health problems.

"We have to accept the prospect of treatments being excluded from the NHS if we want to maintain a universal service, one which is available everyone and essentially free at the point of use," he said.

Dr Ian Bogle: "Rationing is the answer"

The public is no longer convinced that extra money going into the NHS is being spent effectively by governments, says the report.

A hypothecated, or ring-fenced tax, for the health service is "unlikely to provide any advantages" over the present system.

A spokesman for the BMA said: "They examined all the other options, and this was the only one that was possible.

"The idea of patient charges is certainly dead as far as we are concerned. The objections to them are too strong."

Government challenge

Dr Bogle said last year that "baying to the government for more and more money" was unacceptable.

In the absence of the government pumping in more cash the only option left was to reduce the amount of treatments that the NHS has to pay for.

John Appleby, director of health systems at the independent think tank, The Kings Fund, said: "The Healthcare Funding Review points out that the NHS cannot provide all the health care that we could possibly want from it.

We welcome the BMA's agreement with us that a tax-funded health system suits the needs of the UK best

Department of Health

"That is true of every health system in the world.

"The challenge for the government and the NHS is to accept this reality and involve the public in resolving the dilemmas that this creates."

However, the document stops short of recommending tax breaks for private healthcare.

"We do not see tax relief on private medical insurance or other fiscal incentives as a particularly efficient way of spending public money," said Dr Bogle.

'Founding principles'

A Department of Health spokesman said: "We welcome the BMA's agreement with us that a tax-funded health system suits the needs of the UK best.

"This government wants the future NHS to be fast, modern and convenient for patients - but to be soundly based on its founding principles.

"It should be taxation funded, free at the point of delivery and available to all."

Shadow health secretary Dr Liam Fox welcomed the BMA report.

He said: "It is clear that the BMA have been willing to grasp what the government has refused to accept - that rationing exists and that, in a world where medicine is expanding faster than our ability to fund it, choices will increasingly have to be made and priorities set."