Call for national body to oversee health decisions

GLENDA COOPER

Health care should be a "right" of citizenship rather than "matter of privilege or luck", and a national commission must be set up to make decisions consistent across the country, according to a left-wing think-tank.

Anna Coote, deputy director of the Institute for Public Policy Research, told the Hard Choices in Health Care conference yesterday that "explicit rationing" in the National Health Service was "being done more openly by different people and more intensively than in the past".

She added: "The truth is the treatment that is available in one area may not be available in another. What one authority provides another denies. Health provision is a lottery with different services available in different areas. What you get can depend on where you live rather than what you need."

She said that the case of Jaymee Bowen (child B) was not an isolated one. "Decisions like this are being taken everyday by unelected, unaccountable health authorities. The weight of these decisions places an unfair burden on the professions at local level. What we need is a strong clear framework for decision-making to guide and support clinicians and managers, one that the public can understand."

A national health commission would represent all stake holders in the health service: doctors, nurses, ethicists, economists, social scientists and the public.

It would define equitable effective and efficient treatments and would work out how the balance between them could be achieved. It would also address questions about the boundary between health and social care, the role of central government and local flexibility. While not creating an absolute list of which treatments will or will not be provided "it must be clear enough to offer meaningful guidance and flexible to deal with the range of individual cases and the pace of medical developments and change," said Joanne Lenaghan, health policy researcher at the IPPR.

Harriet Harman, Labour's health spokesman, added: "There is general agreement that dissemination of information about treatments should be as quick as possible and put into practice as quickly as possible and it is clear that it should be led from the centre."

The IPPR also supports the use of "citizens juries" - 12-25 members of the public who meet for about five days to deliberate policy. They have already been used in America and Germany to decide issues such as whether a new road should be built as well as assessing new policies for health and welfare.

"They are presented with enough information so they can make informed decisions," Miss Lenaghan said. "Jurors are not asked to give a simple yes or no. This is not a jury in the OJ Simpson mould ... if a national health commission is set up citizens juries could have an input into [its] work."