Two major issues emerged at the launch last week of the BMA's review of healthcare funding in the United Kingdom. Participants at a London seminar, held to kick off the debate, wanted a system that protected the most vulnerable populations in society—particularly mentally ill people—and one that was equitable, so that proved treatments available to patients in one area were available to patients everywhere.
But none of the 40 participants could offer a solution to the problem that some patients would always be able to buy the most up to date drugs and procedures before they had been proved to be cost effective, whereas others would not.
The BMA's review, which was announced last year when the NHS was showing particular signs of strain, is expected to last about a year. It is separate from the government's plan to update the NHS in England (15 April,p 1027). Last week's BMA seminar, hosted by the broadcaster Nick Ross, was the first of several that will be held throughout the summer.
The review team has already called for written evidence, with a deadline of 26 May, and has commissioned a number of research projects and opinion polls.
Participants at the London launch included representatives from the Patients Association, the Carers National Association, Age Concern, and the Long Term Medical Conditions Alliance, as well as the royal colleges, the health insurance industry, the pharmaceutical industry, and the BMA.
Nick Ross opened the proceedings by asking how many participants thought that the NHS was the only model for delivering health care in the future. Less than half thought that it was.
But representatives of certain patients' groups spoke strongly in favour of maintaining a tax based system like the NHS to protect the most vulnerable populations.
Cliff Prior of the National Schizophrenia Fellowship said: “The nature of funding is crucial to this debate. Mental health care is not covered well by private insurance systems, such as [the system] in the United States. When we look across the pond, we see our fellow sufferers excluded from health care.”
Barbara Meredith, from the Patients' Forum, said that many people blamed increased demand from patients on consumerism, but that the pharmaceutical industry was investing enormous sums of money in creating demand for certain products. “When we blame consumerism, we are leaving out some of the drivers of demand,” she said.
Trevor Jones, director general of the Association of the British Pharmaceutical Association, disagreed. “A lot of people are kept in the dark and are not aware of what is available,” he said. “Every year, we [the pharmaceutical industry] put 40 entirely new drugs onto the market. We need to find ways of using them, rather than recommending therapies that are 25 years old. If a patient says that they want a new, more expensive drug, should they not be given it?”
The steering group is expected to put together a final report in the autumn for publication early next year.
More details about the review can be found on the BMA's website (www.bma.org.uk).
Figure.
A 10 minute rule bill on presumed consent to organ donation—proposing that doctors can assume that patients have consented to donate their organs after death unless they have specifically opted out—was passed in the House of Commons last week by a majority of 113 votes to 23. The bill, put forward by Nicholas Palmer, Labour MP for Broxtowe, is scheduled for its second reading on 21 July but stands little chance of becoming law. It was welcomed, nevertheless, by the BMA because it drew attention to the acute shortage of organs for transplantation. Statistics issued by the United Kingdom Transplant Support Service Authority show that between 1990 and 1999 the numberof kidney transplantations from cadavers fell by 21% (from 1875 to 1476), but the waiting list rose by 57% (from 3849to 6045).