I was heartened to read the results of the recent NHS Confederation Mori poll (1) which asked the general public who should decide on the availability of NHS medicines:

  • 70 per cent said clinicians
  • 33 per cent said patient representatives
  • 23 per cent said NHS managers and
  • Only 9 per cent said MP’s and
  • Only 6 per cent said local councillors.

This appears to be a massive vote of confidence for Nurses and Doctors on behalf of the general public.

The question of political control of the NHS is being hotly debated at the moment. Rationing of new expensive treatments is one key confluence of national politics and clinical decision-making where the issue of political control is often tested to the utmost. There is a long saga of dramas on the subject from the child B case to the more recent court cases over the availability of herceptin. This poll seems to indicate that the public trust the clinicians as the final arbiter in each local circumstance. The question is – would they if the reality was that it was their own life on the line rather than the abstract case? If they did, the issue of rationing would be solved once and for all, and the service could largely manage itself. It would also allow each individual trained nurse and doctor to use their years of training and experience to better effect for the nation. Power to the clinicians.

(1) Health Services Journal: 25th January, 2007 pp 9 see article ‘Prescribing: survey suggests public wants treatment rationing left to clinicians and managers’.