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Healthcare funding review

Preface
For many years the BMA has been concerned at the apparently large and widening gap between the resources available for healthcare and the demands and needs of patients. The substantial funding increases announced during 1999 and 2000, were seen by many, not least the government itself, as a solution to the crisis. Although we welcome the extra funding and the political commitment it represents, the problems facing the NHS are more fundamental and need more robust long term solutions. We have therefore initiated a review of healthcare funding, bringing on board representatives of patients, NHS managers, other professions and the private healthcare sector. The review set out to answer four questions:

• What kind of healthcare does the public expect, want or need?
• What resources are required to provide this?
• Can these resources be reasonably expected to be provided under present or alternative funding arrangements?
• What mechanisms can be used to bridge any ‘affordability gap’ that may emerge?

No report could do full justice to the wide-ranging debate which has taken place around these questions, to the mass of evidence which has been submitted to us or to the complexity of the issue. Questions of funding are difficult to separate from those of organisation and policy. This report strays into, but does not begin to address adequately, areas such as public involvement in shaping services locally, public health initiatives and developing the roles of nurses and other healthcare professionals. Its conclusions derive from background research and supporting evidence, published as annexes to the report. Readers are invited to refer to these annexes for further information.

This report reflects the outcome of the review process rather than the policy of the BMA or other member organisations. It is intended to be used as a consultation document which these and other interested organisations are invited to use in the process of formulating their own views on healthcare funding in the UK.

The healthcare funding review was conducted by the BMA’s health policy and economic research unit, under the leadership of a steering group consisting of :

Dr Ian Bogle, chairman (Chairman of Council, BMA)
Dr James Appleyard (Treasurer, BMA)
Mrs Vanessa Bourne (Chairman, Patients Association)
Dr John Chisholm (Chairman, BMA GPs Committee)
Ms Donna Covey (Director, Association of Community Health Councils)
Mr Maurice Dunlop (Chairman, BMA, Northern Ireland)
Dr John Garner (Chairman, BMA, Scotland)
Mrs Christine Glover (President, Royal Pharmaceutical Society of Great Britain)
Mr Peter Hawker (Chairman, BMA Central Consultants and Specialists Committee)
Dr Andrew Hobart (until July 2000), Dr Trevor Pickersgill (from September 2000) (Chairman, BMA Junior Doctors Committee)
Professor Trevor Jones (Director General, Association of the British Pharmaceutical Industry)
Professor Roddy MacSween (until July 2000), Professor Sir Denis Pereira Gray (from July 2000) (Chairman, Academy of Medical Royal Colleges)
Dr Terence Morris (Chairman, BMA Wales)
Ms Deborah Rozansky (Director of Corporate Affairs, Royal College of Nursing)
Dr Colin Smith, (Chairman, BMA Medical Academic Staff Committee)
Dr Sarah Taylor (until July 2000), Dr Eddie Coyle (from September 2000) (Chairman, BMA Committee for Public Health Medicine and Community Health)
Dr Andrew Vallance-Owen (Medical Director, BUPA)

We are also grateful to the many other organisations and individuals who contributed to the review, in particular Ms Sue Antrobus of the RCN, Dr John Appleby of the Kings Fund, Dr Philip Collins of the Social Market Foundation, Mr John Coss of the Institute of Actuaries, Mr Richard Darch of First Consulting Group, Mr Nigel Edwards and Mr Stephen Thornton of the NHS Confederation, Mr Barry Elliott of the HFMA, Mr Mike Evershed and Ms Rebecca Lawrence of the Treasury, Ms Kim Fellows and Dr Richard Tiner of the ABPI, Ms Judy Hargadon of the Changing Workforce Programme, Dr Alison Hill formerly of the Kings Fund, Ms Joanna Howard, Dr Justin Keen of the Kings Fund, Mrs Sheila Kelly of the Proprietary Association of Great Britain, Mr Graeme Leach of the Institute of Directors, Mr Gerry Marr of the Scottish Executive health department, Mr John McGuigan of Frontline Management Consultants, Ms Barbara Meredith of the Patients’ Forum, Professor Allyson Pollock of University College London, Mr Cliff Prior of the National Schizophrenia Fellowship, Professor Ray Robinson of the London School of Economics, Professor Peter Smith of the Centre for Health Economics, Mr Adrian Towse and Mr Jon Sussex of the Office of Health Economics, Ms Judy Wilson of the Long Term Medical Conditions Alliance and Dr Ron Zimmern of the Public Health Genetics Unit. No responsibility for the omissions or commissions of the report should be attributed to contributors.

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