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Towards a model of healthcare delivery

June 2008

Introduction
Through the BMA’s Caring for the NHS campaign the medical profession has demonstrated its desire to play a leading part in recasting health service reform and to express an enduring commitment to the NHS. Although critical of a large number of specific reforms introduced since the year 2000, the medical profession, in chorus with other groups allied to the NHS, has repeatedly voiced the more general concern that the volume of reform to which the NHS in England has been subject, and the pace of its introduction in recent years, has both destabilised the health service and alienated large sections of its dedicated staff.

The BMA, however, has not simply criticised reform from a distance but has chosen to advance alternative perspectives that might better achieve the objective of an NHS fit for the 21st century. To this end, the BMA has urged the Government to enter into a constructive and meaningful dialogue with the medical profession, other NHS professionals, the public and patients in order to realise a new approach to reform that will safeguard the future of the NHS.

We have consulted widely – not only amongst the medical profession but engaging all parties who share a relationship with the NHS – and have developed a range of proposals for a way forward that we think will ensure the NHS can deliver improving health to the population in an efficient and equitable manner, honouring a set of shared values and principles to which all those that are invested in the NHS can subscribe, and in the context of a system that supports cooperation and collaboration in the operation of the service.

In its discussion paper, ‘A rational way forward for the NHS in England’ the BMA made clear its view that developing a responsible approach to the issue of resource allocation is integral to meeting the challenges facing the NHS in the 21st century. As the NHS celebrates its 60th birthday it must build on the structures which have worked to date whilst recognising that locally managed and responsive services cannot be delivered in a monolithic framework. Our desire to see the NHS committed to equity and accountability requires a funding mechanism which delivers resources to local health economies on the basis of equal access to those in equal need and which, below this level, is flexible enough to fund local models of service for local populations the design of which are determined by the populations themselves.

At the same time, the BMA is committed to an approach which is based on cooperation rather than competition and, consequently, we remain concerned that current NHS reform provides an increasing role for the commercial private sector and the development of a market in NHS care. We believe this threatens the stability of the NHS and undermines the spirit of collaboration which is central to the success of the NHS. As a result, we envisage a much more peripheral role the commercial private sector with its use limited to those areas where existing providers are unable or unwilling to meet demonstrable demand and only when it will function to complement existing capacity, and not undermine the comprehensive delivery of healthcare. The model of healthcare delivery outlined in this paper is a response to these challenges.

A full copy of the report can be downloaded in PDF format from the link on the right hand side of the page.