Are we too pessimistic about the future of the NHS?

June 29, 2000

Education and debate: The limits to demand for health care

Commentary: An open debate is not an admission of failure

The widespread belief that the NHS is doomed to failure - as demand continues to exceed supply - is called into question in this week's BMJ.

Frankel and colleagues at the University of Bristol suggest that conventional assumptions of an imbalance between demand and supply are not supported by evidence. Similarly, pessimism about future trends in demand as the population ages, new technologies appear, and public expectations rise, are unsupported by good evidence.

The authors criticise the current process of rationing for being unscientific and selective. There are examples of failure to meet demand, they say, but the discrepancies are "trivial" and "there seem to be no real barriers" to demand being satisfied. They also question the "doomsday scenarios" often predicted as the population ages and new technologies appear, citing evidence that healthcare expenditure does not depend on age and that many new technologies cut costs. They conclude that "much of the failure to meet demand is unnecessary" and see public expectations and professional self interest as greater problems.

In an accompanying commentary, independent health policy analyst Bill New, praises the authors for producing "an excellent catalogue of evidence opposing the view that the NHS is incapable of coping," but suggests that "demand will always exceed the ability of resources to satisfy it and that, therefore, some kind of rationing is inevitable." He argues that an open debate about rationing "is not an admission of failure but an attempt to sustain the NHS by being brutally honest about its inevitable limitations as well as its considerable capabilities."
Contacts: [Paper] Stephen Frankel, Professor of Epidemiology and Public Health Medicine, Department of Social Medicine, University of Bristol, Bristol BS8 2PR Email:

[Commentary] Bill New, Independent Health Policy Analyst, 9 Countess Road, London NW5 Email:


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