Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 2002 Jul 13;325(7355):101.

Gold for the NHS

No natural limitation exists on demand for services free at point of supply

Brian Campbell 1
PMCID: PMC1123596  PMID: 12114246

Editor—By far the most encouraging sentence in Robinson's editorial is the last: “There is a strong case for arguing that . . . UK healthcare policy should be driven by the supply side rather than the demand side reform.”1 Yet there is not a word of this from the chancellor or the secretary of state or in the report by Wanless, whose terms of reference guaranteed his conclusions. Even working within those limitations Wanless managed to generate some gratuitous drive, saying that the cost of health care is likely to fall as we take greater measures to improve our health.

There may have been some excuse for Aneurin Bevan's assessment of budgetary realities, but surely 54 years' unvarying experience has been enough to convince us of the truth of another health secretary's assessment (Enoch Powell's): there is no natural limitation on the demand for any good or service free at the point of its supply. Until that is grasped and fully understood, those working in the NHS will continue to be the poorly paid providers of inferior care to an ungrateful public.

References

BMJ. 2002 Jul 13;325(7355):101.

What exactly is being bought with this gold?

Peter Davies 1

Editor—Two concerns came to me when I read Robinson's editorial about the plans for unprecedented rates of growth in NHS spending.1-1

The first is, what exactly is the government buying with the extra billions it is spending on the NHS? Is it hoping to buy more medical treatment on behalf of the public? Is it hoping to make the population healthier by so doing?1-2 If it is the first of these then the government has some hope of achieving its aims, although where the extra staff are going to be brought from is not clear. If the government is hoping to make a difference to the overall health of the public by spending through the NHS system it is mistaken. Any treatment system such as the NHS can only deal with the casualties of life, not with how to live healthily in the first place.

This brings me to my second concern: that simply concentrating on supply side measures will pander to medical vanity (treatment as all important) and move thinking away from looking at how and why demand for medical services arises in the first place.

Unless we as individuals and as a society are able to encompass the full picture of health, including its environmental factors, its social relationships, and its political and moral dynamics, we will continue to find health puzzling and frustrating. We must start to examine the sources of demand for health care and learn to modify them early. This will require courageous medicine and courageous politics.

References

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES