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A review of the consequences of additional private drugs for NHS care

Reivew led by Professor Mike Richards on behalf of the Secretary of State for Health

BMA response, August 2008

Introduction
The BMA welcomes the opportunity to contribute to the review of the consequences of additional private drugs for NHS care.

The BMA is a voluntary, professional association that represents all doctors from all branches of medicine across the UK. Over 100,000 practising doctors are members, as are nearly 20,000 medical students. The BMA is an independent trade union, a scientific and educational body and a limited company, funded largely by its members.

The terms of reference of the review reflect the growing pressures currently being experienced in the NHS as a result of ever-rising public and patient expectations, the increasing costs of new medicines and technologies and the realities of an NHS operating in the context of finite resources. We note that the review has limited its focus to the issue of additional private drugs, rather than treatment more broadly. However, it is our belief that a much wider debate is required to allow for both the examination of existing guidance in this particular area and the exploration of a range of related, significant issues that lie beyond the scope of the current review.

In particular, the review highlights the larger tension that exists between the principles of equity and autonomy in a modern, tax-funded health service where patient choice plays an increasingly central role. In so doing, the review exposes the growing need to reconcile the role and operation of an NHS wedded to the habitual exercise of rationing healthcare with the growth of a consumer-orientated, information-rich society. Given the complexity of these issues – social, economic, legal and ethical - that must be addressed by the review in determining its recommendations, we are disappointed by the challenging time-table to which the review must report.

Moreover, with an inevitable consequence of the review being the encouragement of wider debate on funding pressures in the NHS and with it matters such as ‘rationing’, the ‘postcode lottery’, ‘top-ups’ and ‘co-payments’, we hope that the Secretary of State’s decision to launch the review signals an intent to initiate a mature and open dialogue with the public, patients, health professionals and others on these broader issues.

The BMA has, for many years, expressed serious concerns about the failure to address these long-standing, contentious issues, and we would not wish to see them side-stepped in favour of addressing a much narrower question. This would prevent fuller public engagement and threaten to encourage far-reaching decisions being taken in the absence of a considered and informed public, professional and political debate.

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