Bottomley admits NHS rationing is inevitable: Government defines its health role as offering strategic direction but leaves 'priority-setting' decisions to doctors and managers. Judy Jones reports

The Government yesterday insisted that rationing in the National Health Service is inevitable, but delegated responsibility for setting priorities and guidelines to doctors and managers.

Virginia Bottomley, Secretary of State for Health, defined the task of ministers as giving 'strategic direction' to the NHS, leaving health authorities and health service staff to decide how best to meet patients' needs.

In a speech to a conference of NHS professionals and academics on rationing in London, Mrs Bottomley acknowledged rationing decisions had been made more explicit with the creation of an internal market. The range of hospital services now depended on the willingness and ability of the purchasers - family doctor fundholders and district health authorities - to fund them.

'The NHS must continually assess and evaluate the work it does. Only by doing so can priority be given to effective treatments, and ineffective treatments weeded out,' Mrs Bottomley said. 'The treatments we provide must prove their worth in three different ways. They must meet the needs of patients; they must have good outcomes and be related to the quality of life, and they must represent value for money.' The challenge was to make best use of NHS resources against the background of an ageing population with growing expectations and with the 'potential to heal pushed to ever greater limits' by new technology. We should not accept the theory that the NHS is rushing towards a rationing Armageddon. Sensible practitioners and politicians have known all along that difficult decisions about priorities have to be taken.

Later, the minister told reporters she preferred to talk about 'priority-setting' than 'rationing'. She said: 'The word rationing has all sorts of associations that are not appropriate to the NHS.'

However, the Secretary of State's speech appeared to disappoint some doctors and managers attending the conference, who had hoped for a stronger lead from government over the way rationing should operate. In many parts of the country, patients of GP fundholders have shorter waits for operations than other patients. Many hospitals ran out of money for routine surgery over the winter and can only treat patients with the most urgent conditions until new contracts are signed in April.

Later, David Blunkett, Labour's health spokesman, accused Mrs Bottomley of producing 'another confusing fudge' that ignored the reality of lengthening waiting lists and bans on treatment faced by many patients. 'The Secretary of State is being less than honest. The combination of underfunding and the internal market has led to rationing, growing delays for urgent treatment, and some activities disappearing.'

Rudolf Klein, Professor of Social Administration at the University of Bath, told the conference there was still too little hard information to ensure a reasoned debate about priority-setting and rationing.

Doctors should give low priority to free sex change operations on the NHS, Mrs Bottomley said on BBC's Newsnight last night. They were 'quite at the margins' of the service.

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