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.