"Rationing is reduction in choice. Rationing has become a necessary evil. We need to formalise rationing to prevent an unregulated, widening, postcode-lottery of care. Government no longer has a choice." - ALEX SMALLWOOD, BMA
Story in full THE government and NHS must be more open with patients about the need to ration treatments and services in a system with a limited pot of cash, doctors said yesterday.
The British Medical Association conference heard that rationing was inevitable and a "necessary evil" in today's health service.
Scottish doctors also warned that targets which did not improve patients' care were being given preference to funding treatments which would make a difference.
It comes after growing discontent over decisions made by NHS rationing bodies in the UK, including the Scottish Medicines Consortium.
Patients have voiced anger that new, but expensive, treatments are denied them on the NHS.
In some cases they are available in Scotland, while patients in England go without.
Alex Smallwood, from the BMA's junior doctors' committee, told the meeting in Torquay it needed to be accepted that rationing must take place in the NHS, but this had to be done much more openly.
"It is no longer possible to provide all the latest to absolutely everybody without notable detriment to others," he said.
"Rationing is reduction in choice. Rationing has become a necessary evil. We need to formalise rationing to prevent an unregulated, widening, postcode-lottery of care. Government no longer has a choice."
Dr Smallwood said that a list of acceptable treatments could be drawn up after debate and public consultation.
But this might include a restriction on treating things like hernias and varicose veins - conditions with which people could live. "If somebody had a specific condition, it would be about how you could fairly say to them, 'This is not life-threatening; there's probably a better way we could manage this'.
"When it comes to the list of conditions, it's all about quality of life. It would be about the prioritisation of clinical need," he added.
Dr Smallwood said a contract could be drawn up to help clinicians decide which treatments could be rationed.
"If people know what is available then you might not raise expectations unnecessarily," he added.
Dr Andrew Thomson, a GP in Angus and chair of the BMA's junior members' forum, agreed the government and NHS needed to be open with patients about what was available with a limited pool of cash.
"What needs to happen is a transparent and honest debate about what the NHS can and cannot pay for," he said.
"Patients can expect that the NHS will still meet their clinical needs. What we need to make sure is that all the treatments that are provided are evidence-based and taxpayers' money is not being wasted."
Dr Thomson said he was worried that the SNP-led Executive would introduce yet more targets for the NHS, which distorted clinical priorities.
The BMA conference voted overwhelmingly in favour of a motion which stated: "The target-driven NHS distracts from quality of care by distorting the true needs of patients. We demand that the BMA ensure that NHS services are outcome-led rather than target-driven."
Nicola Sturgeon, Scottish health secretary, said:
"There is no question of targets changing or distorting clinical priorities; for example, boards must ensure cancer patients are treated within a 62-day target."
'Disastrous' system forces talented young medics to leave Scotland for work
DEBORAH White wants to be a GP, and most of all she wants to be a GP in Scotland. But the chaotic new recruitment system that has left junior doctors scrabbling for jobs means she must now leave the country that trained her, at a cost to the taxpayer of about 250,000.
After months of uncertainty, the 29-year-old has been offered a job in the north of England - the exact location is still unknown - starting on 1 August. She sees herself as one of the lucky ones, as friends and colleagues head overseas to escape the disaster that has unfolded across the UK.
It is a situation that was forcefully highlighted at the British Medical Association's conference in Torquay yesterday.
The Modernising Medical Careers training system will also be debated today as junior doctors from across the UK come together to voice their outrage.
Yesterday, Nicola Sturgeon, the Scottish health secretary, said the Executive was considering following England's lead and making sure all juniors had a job until at least October. After that, the situation is less clear.
It is still not known how many doctors living in Scotland will be without a job, but it could be several hundred.
For Dr White, the crisis means she has missed out on a training place in Scotland, perhaps with less talented applicants taking the jobs.
"I trained at Aberdeen University and I have already worked in Aberdeen," she said. "I truly wanted to continue working here with patients in Scotland. But, at the end of the day, I need a job and so I am going to have to move, even though I don't want to.
"Even so, I have to think myself lucky. Many of my colleagues in Scotland are now heading abroad, to Australia and New Zealand, because they have not got training jobs."
She went on: "The system has just been a disaster. It has left doctors anxious and depressed."
GP: BAN DRINKING ON OUR STREETS
GANGS of youths should be banned from drinking on the streets of Scotland, the BMA conference will be told today.
Doctors will hear calls for a roll-out of local schemes already operating in parts of Scotland's cities where the consumption of alcohol is banned on the streets.
Doctors want this extended to all residential and shopping areas in a bid to crack down on alcohol-related violence and public disorder.
Dr Ian Thompson, a locum GP in Glasgow, said there was a strong case for extending the schemes in Scotland and across the UK.
But he said they should be aimed at places where people lived and worked, rather than banning people having a drink during a picnic in the countryside.