CONGRATULATIONS on your excellent editorial 'Hard choices on health' (17 April). As a consultant who has recently retired from the NHS, I have lived through the plethora of management 'reforms' that have dogged its history and, in my opinion, have deprived it of proper development. The most recent is the most radical; and has advantages and disadvantages. But all miss the point by ignoring the basic problem.

Given the explosion of knowledge and technical ability in the last 50 years, the 'demand' for health care (in terms of conditions that can now be treated) must exceed the supply (in terms of 'resources' such as expertise and money). Thus there must be rationing.

It is the function of politicians to determine the policy of the NHS - who or what conditions should be treated; and, more importantly, who and what will not be treated within the NHS. It is not acceptable that they should mislead the public by implying that all treatments are available for all the people all the time.

The onerous task of deciding who will or will not be treated should not be placed on the individual doctor (as it has been) or the local manager. Nor should the local 'purchasers' (none of whom are elected) have to decide which type of treatments (and how many) they will buy on behalf of their resident population.

If the NHS is to be a 'national' service, then whether you will get treated, or not, should not be determined by where you live.

M C T Morrison

Consultant Orthopaedic

Surgeon

Swindon, Wiltshire

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