Alan Milburn, England's health secretary, admitted this week that rationing is part of the government's modernisation agenda for the health service.
At a debate organised by the Institute for Public Policy Research in London Mr Milburn said: "The NHS—just like every other health system in the world, public or private—has never, or will never, provide all the care it might theoretically be possible to provide. That would probably be true even if the whole of the UK gross domestic product was spent on health care. So within our expanding health system there will always be choices to be made about the care to be provided." Rationing decisions are necessary, he explained, to ensure that the NHS provides only treatments that will truly benefit patients. "The National Institute of Clinical Excellence [NICE] will help make the hard choices," he said, "and it will also protect patients from low value or obsolete interventions."
Mr Milburn suggested that the institute's rulings will lead to important cost savings: "It is precisely because NICE will point out which treatments are less clinically cost effective that it will help free up financial headroom for faster uptake of more clinically cost effective treatments." He also rejected the proposals put forward recently by the shadow health secretary, Dr Liam Fox, that the NHS can be sustained only by expanding private health insurance or charging patients at the point of treatment.
An expanded private sector, he argued, would have to be staffed by professionals "sucked" out of the state system. The idea that private medicine lightens the load on the NHS runs the risk, he said, of "a service for the poor becoming a poor service, a truth attested to by anyone who has visited a public hospital in a major US city." Charging patients for specific treatments would be a "one-off boost, when what our healthcare system needs is consistent growth in funding to meet the challenges it faces." But Mr Milburn failed to address the criticism that the government spends less on health than other European governments. Jon Ford, head of the health policy and economics research unit at the BMA, said: "Our total expenditure at 6.9% of gross domestic product contrasts with France at 9.6%, Germany at 10.7%, and the average for the 15 European Union countries of 8%. Why can't we spend the same as in Europe? The government is reluctant to put in the funds that the NHS demands."