Former chief scientist condemns internal market in NHS

The internal market in health care is 'counter-productive' to a national health service and to rational decision-making about prioritising treatments, according to Sir Douglas Black, a former government chief scientist, writes Liz Hunt.

Sir Douglas, who chaired the committee which produced the Black report on the link between poverty and health, argues that the introduction of GP fund-holding and hospital trusts has 'prejudiced the cohesion' of the NHS which, until now, had safeguarded equity of health care.

The changes have delegated decision-making - including rationing of some treatments - to managers. But a health service cannot be run like a business, nor is line management superior to consensus management, which worked well until it was 'submerged in a succession of theoretically-based reorganisations', he says in a new report from the Office of Health Economics, a research body funded by the pharmaceutical industry. He writes: 'A genuine or 'perfect' market in 'health care', even if it were desirable, may be unachievable, in view of the complexity and uncertainty of the putative merchandise. An artificial or 'managed' market, besides being alien to an equitable national service, carries within itself the reasons for its own failure.'

Sir Douglas says he is in favour of the 'Oregon' approach to healthcare rationing. Almost 700 medical treatments available in Oregon, in the US, were ranked on the basis of efficacy and cost, the seriousness of disease, and its prevalence. State funding was approved for 568 of the treatments.

Sir Douglas said: 'One possible objective basis for 'prioritisation' in the NHS could be further analysis of available medical and surgical interventions in terms of their cost and their benefit, taking account of both quality and duration and survival. Techniques for doing this are developing, and should be encouraged further . . . If this had preceded, instead of following the 'reforms', we might have had a happier story.'

A Doctor looks at Health Economics; Sir Douglas Black; Office of Health Economics, 12 Whitehall, London SW1A 2DY; price pounds 5.

PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
News
ebookA unique anthology of reporting and analysis of a crucial period of history
Independent
Travel Shop
the manor
Up to 70% off luxury travel
on city breaks Find out more
santorini
Up to 70% off luxury travel
on chic beach resorts Find out more
sardina foodie
Up to 70% off luxury travel
on country retreats Find out more
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Foundation Phase Teacher required

£90 - £110 per day: Randstad Education Cardiff: Exciting opputunities availabl...

Learning Support Assistant

£65 - £70 per day: Randstad Education Cardiff: Due to the continual growth and...

Learning Support Assistant - Newport

£65 - £70 per day: Randstad Education Cardiff: Due to the continual growth and...

Operations Manager

competitive: Progressive Recruitment: I am currently recruiting for an Operati...

Day In a Page

Save the tiger: The animals bred for bones on China’s tiger farms

The animals bred for bones on China’s tiger farms

The big cats kept in captivity to perform for paying audiences and then, when dead, their bodies used to fortify wine
A former custard factory, a Midlands bog and a Leeds cemetery all included in top 50 hidden spots in the UK

A former custard factory, a Midlands bog and a Leeds cemetery

Introducing the top 50 hidden spots in Britain
Ebola epidemic: Plagued by fear

Ebola epidemic: Plagued by fear

How a disease that has claimed fewer than 2,000 victims in its history has earned a place in the darkest corner of the public's imagination
Chris Pratt: From 'Parks and Recreation' to 'Guardians of the Galaxy'

From 'Parks and Recreation' to 'Guardians of the Galaxy'

He was homeless in Hawaii when he got his big break. Now the comic actor Chris Pratt is Hollywood's new favourite action star
How live cinema screenings can boost arts audiences

How live cinema screenings can boost arts audiences

Broadcasting plays and exhibitions to cinemas is a sure-fire box office smash
Shipping container hotels: Pop-up hotels filling a niche

Pop-up hotels filling a niche

Spending the night in a shipping container doesn't sound appealing, but these mobile crash pads are popping up at the summer's biggest events
Native American headdresses are not fashion accessories

Feather dust-up

A Canadian festival has banned Native American headwear. Haven't we been here before?
Boris Johnson's war on diesel

Boris Johnson's war on diesel

11m cars here run on diesel. It's seen as a greener alternative to unleaded petrol. So why is London's mayor on a crusade against the black pump?
5 best waterproof cameras

Splash and flash: 5 best waterproof cameras

Don't let water stop you taking snaps with one of these machines that will take you from the sand to meters deep
Louis van Gaal interview: Manchester United manager discusses tactics and rebuilding after the David Moyes era

Louis van Gaal interview

Manchester United manager discusses tactics and rebuilding after the David Moyes era
Will Gore: The goodwill shown by fans towards Alastair Cook will evaporate rapidly if India win the series

Will Gore: Outside Edge

The goodwill shown by fans towards Alastair Cook will evaporate rapidly if India win the series
The children were playing in the street with toy guns. The air strikes were tragically real

The air strikes were tragically real

The children were playing in the street with toy guns
Boozy, ignorant, intolerant, but very polite – The British, as others see us

Britain as others see us

Boozy, ignorant, intolerant, but very polite
How did our legends really begin?

How did our legends really begin?

Applying the theory of evolution to the world's many mythologies
Watch out: Lambrusco is back on the menu

Lambrusco is back on the menu

Naff Seventies corner-shop staple is this year's Aperol Spritz