BMA orders full review of all health funding

A ROOT-and-branch review of the funding of the NHS was ordered by the British Medical Association yesterday amid growing complaints from doctors that the existing system can no longer provide comprehensive care.

Leaders of the association said no option would be ruled out for the review, which could include restricting the NHS to a range of core services, imposing charges or introducing private insurance. Patients, managers and others from outside medicine would be invited to join the review which would report within a year.

The announcement came 24 hours after Alan Milburn, the Secretary of State for health, ruled out charges and private insurance as means of boosting the NHS coffers. In a speech to the first annual conference of the National Institute of Clinical Excellence (NICE) on Wednesday he said charges would fall on the elderly and the young, who had most need of the NHS but who could least afford to pay, while private insurance would be affordable only for those least likely to claim on it.

"The NHS is both fairer and more efficient than the privatised alternative. We reject the private option as intrinsically flawed," he said.

Dr Ian Bogle, chairman of the BMA, said Mr Milburn's remarks would not divert the association from its review. In a barbed reference to the brief careers of most ministers, he said Mr Milburn's comments mattered "only if you think he has the last word".

But yesterday Stephen Thornton, chief executive of the NHS Confederation, said the solution was "not to be found" from private revenue. He said he saw no reason why a tax-funded NHS should not provide for "all citizens' reasonable heathcare needs".

Dr Bogle said there was a widening gap between the resources available and the demands of patients. One member of the BMA's council had reported receiving a letter from his health authority because he was overspent on his prescribing budget, though his prescribing figures were below the national average. "It is not over-prescribing, it is underfunding," Dr Bogle said.

BMA policy is opposed to introducing charges for NHS treatment, despite the fact that the UK imposes among the lowest charges for basic medical care in the Western world.

Another possibility to be explored is that of restricting the services provided under the NHS. "Universal coverage means cover for all. It does not necessarily mean cover for everything," Dr Bogle said.

The review is certain to examine the low proportion of GDP spent on health in the UK - 6.7 per cent in 1997, against 9.9 per cent in France and 10.4 per cent in Germany. State spending as a percentage of GDP is about the same in most European countries; the UK falls behind because there is less private spending on health.

Dr Mac Armstrong, secretary of the BMA, said: "We know what the Government says it is prepared to pay for a tax-funded service. What has not been explored is what the public is prepared to spend on health."

Dr Armstrong said the wool was being pulled over patients' eyes about the true state of the NHS. "We pay [through taxation] for a service that is comprehensive, not only available to all but which covers everything. But it just isn't true. It doesn't cover everything and it is not available to everyone, everywhere. Why do we perpetuate this myth?

Cancer consultants yesterday criticised the Government's strategy to set maximum waiting times of two weeks for referral to a specialist. Specialists said the new deadline, introduced last April for breast cancer and to be extended to all cancers from next April, was already delaying treatment for patients who needed it while doctors checked suspect cases who did not have the disease.