The case against

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Abstract
In many ways this is an unsatisfactory state of affairs and not surprisingly has increasingly come under challenge. There are two main grounds for criticism. Firstly, the present situation allows ministers to duck responsibility for the consequences of their decisions when setting the NHS's budget. If “adequacy” remains an elastic and fuzzy notion, there is no way of establishing whether the budget is sufficient to meet the NHS's commitments. Without any definition of what those commitments are in the first place, the debate about whether or not the NHS is “underfunded” becomes a meaningless dialogue of the deaf and accountability is fudged. Secondly, the lack of any defined package means that in practice there can be no equity, if by equity is meant that everyone should have the same opportunity of treatment for any given degree of need for a particular healthcare intervention. A considerable degree of arbitrariness remains in the chances of getting treated in the NHS: even if equity were achieved in terms of ensuring that all …

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