British Medical Association (BMA) leaders yesterday launched what they described as their ‘Green Paper’ for an NHS of ‘core services’ run by an independent board of governors selected and appointed by parliament.
The 80-page document A rational way forward for the NHS in England was introduced by Chair of the BMA Council, Mr James Johnson and Chair of the BMA General Practitioners Committee Dr Hamish Meldrum at a press conference at the BMA head office in central London.
Johnson told reporters there is ‘intense unhappiness amongst the profession and pretty much the whole of the health service with government reforms’.
He said there is ‘discontent over the marginalisation of the profession that goes back to Mrs Thatcher’s reforms’.
He added that ‘nobody wants’ an American-style health system.
He said there ‘has to be equity – spending money where it is needed most and not where it is not needed most’.
Johnson stressed: ‘We have fallen over backwards to not have yet another re-organisation of the NHS.’
He added: ‘We have to make the best of what we’ve got.’
Asking ‘how do you stop political dabbling’ in the NHS, he said the document proposes that the ‘running of services be vested in a board of governors’.
Parliament should set the direction of the board of governors who would ‘run the NHS without political interference’.
Johnson said an executive board would be responsible to the board of governors.
This ‘would cascade down to strategic health authorities. We would not expect ministers to be interfering on a daily basis according to the latest story in the press.’
Johnson said he disagreed with prime minister Blair’s remarks ‘that an independent board would not take tough decisions – it would be more likely to take tough decisions than ministers who may be under pressure’.
Asked who would be on such a board of governors, Johnson said: ‘It may be a venture capitalist from Texas, though that is not likely, clinicians, member of the public – the government will decide.’
GPs Committee Chair Meldrum told reporters: ‘We are proposing an NHS constitution, and priority setting rather than rationing.
‘The constitution would restate core values and add new ones.
‘You have to tell the public what it can expect from the NHS and what the NHS expects from them.’
Meldrum insisted: ‘The BMA is not advocating rationing nor are we saying doctors are calling for rationing.’
However, he added: ‘But we are realistic and due to rising costs recognise it is inevitable.
‘We want it to take place in an open and not hidden way as it is at the moment.’
He continued: ‘We would expect core services to be available to all patients.
‘However, some services, due to cost and clinical worth, may not be available.
‘We are not going to name what would or what would not be available.’
Asked what the document meant by ethical rationing, Meldrum said that ‘parliament sets the agenda, decides what resources are available’.
He insisted that ‘we are in favour of ethical rationing. We are not in favour of rationing; we are saying if rationing needs to take place it has to be done on an open basis’.
Meldrum clearly realised he was skating on thin ice as Clause 13 of the document states: ‘We need an admission from the government and politicians across the board that the NHS will not be able to provide all services.’
And Recommendation 2 states that ‘priority setting and, hence, rationing is inevitable if we are to retain an equitable approach within limited resources’.
Asked who will decide what is ‘equitable’, Meldrum said ‘society should decide’.
When it was pointed out that there are opposing interests in society, Johnson said ‘we have parliament’.
The BMA leaders also made it clear they are not opposed to the private sector continuing in the NHS.
Johnson assured the press conference: ‘We are not saying the private sector should not take part in the NHS.
‘We are saying it should support it not supplant it.’
