Leading Article: The reality of rationing in the health service

PARLIAMENTARY DEBATES, such as yesterday's on the NHS, are all very well: but they will have little impact so long as Honourable Members seem to inhabit a different world from the rest of us.

The Conservatives argue that Labour has created an NHS in which rationing of treatment is endemic - conveniently forgetting that many of the causes of this rationing are of their own making. Nor was Frank Dobson arguing from a position of strength when he answered the charges. Most people can tell anecdotes about just how thin the NHS has been stretched these last few weeks.

The reality is that rationing is indeed widespread. Local Health Authorities have differing funding priorities, depending on what specialist facilities they already have available. Expensive drugs such as Beta-interferon, used to treat multiple sclerosis, or some medications for mental illness, simply are not available on the basis of need in some areas. This often makes it rational to move to another Health Authority area to secure better care for particular illnesses.

This is to some extent inevitable. Health will be rationed however it is provided, for no country can afford to buy all the health care its citizens have come to expect. Even in the free-market US, where patients demand the best of everything, managed health care is the fashion.

The public understand that the NHS can be made to work better, but will never be entirely free of the "rationing" Mr Dobson denies the existence of. He cannot continue semantically with those denials, for they are contrary to common sense. Apportioning limited resources rationally - which clearly occurs - is the very meaning of "rationing".

The Conservatives may have little credibility: but Ministers would have more themselves if they were publicly to recognise reality.