Rationing of health care 'is fact of life'

DOCTORS have to accept that the idea of free National Health Service treatment for all is a myth, according to their leaders. The British Medical Association's annual conference heard yesterday that the association recognises the need for state health care rationing.

Ministers, patients' representatives and philosophers are being invited to help build a consensus on redrawing the boundaries of NHS treatment through the 1990s and beyond.

Jeremy Lee-Potter, the BMA chairman, told the association's annual conference in Nottingham yesterday that rationing was already an 'unavoidable fact of life', but that it should be applied openly and fairly. 'This issue has to be faced as a matter of urgency,' he said. 'Clear guidelines must be agreed to bring consistency to decisions on medical and surgical priorities throughout the health service. We will never have enough resources to meet demand.'

The BMA is to host a conference on rationing strategy next year as a first step towards placing explicit limits on state health services. Speakers will include philosophers, economists, doctors and politicians, from Britain and overseas.

BMA representatives endorsed calls for full public consultation before any system was adopted. However, some delegates fiercely opposed any move towards rationing. They pointed out that cuts in defence spending could release millions for better health care and avert the need for withdrawing certain treatments. Dr Tony Hicklin, representing East Surrey, warned colleagues: 'If you vote for rationing, the Government will take that as an agreement to underfunding of the NHS.'

BMA leaders have yet to draw up a blueprint for rationing. The only model is the experiment undertaken over the last three years in the American state of Oregon. In an opinion survey, 1,000 people were asked to rank about 800 treatments or operatons in order of priority. State funds were allocated only for the top 580 ranked treatments. Among those denied medical treatment, if they are not covered by private health insurance, are Aids sufferers entering the terminal phase of the disease, and babies born with severe handicaps.

While doctors remain deeply divided over the Government's overhaul of the NHS, the conference yesterday reluctantly supported pleas from the leadership to make the best of the new system. Dr Lee-Potter said the profession felt 'wounded' by battles with ministers over GP fundholding and opted-out trust hospitals. But he added: 'The reforms exist. Our task must be to ensure that for the sake of our patients, we do everything we can to make them work.'

Banning all HIV positive doctors and surgeons from practice would risk losing valuable experts from the profession, according to Dr Vivienne Nathanson, the BMA's secretary.

She said doctors were under an obligation not to practice if they were HIV positive and would put patients at risk. But she admitted: 'If you stop everyone who is HIV positive from working you could lose a lot of very good people.'