7 July 2008 - Tom Smith on today’s health policy debate.

It's that time of year when the BMA’s representatives come together for their annual conference. In his first speech as chairman, Dr Hamish Meldrum was keen to show the delegates where he stood in relation to the private sector and market forces in healthcare.

“Where's the balance sheet that shows that the argued-for and promised increase in efficiencies and decrease in costs outweigh the transaction costs and bureaucracy of the market? Show me the evidence that for most of what we do - emergency care, long-term conditions and primary care - the market improves rather than detracts.

"Instead, we get competition, not collaboration; fragmentation, not continuity; inefficiency, not efficiency. Not good for doctors, not good for patients, not good for the NHS”.

The BMA also issued a poll it commissioned, showing the public are worried about the future financing of the NHS. 93 percent of people want the NHS to continue to be funded by tax and 51 per cent disapprove of the policy of involving private companies in the NHS. It shows enormous support for a universal system, free at the point of use, but it also suggests a very large number are comfortable with private sector involvement.

This year the conference is being held in Edinburgh and the Scottish setting has already had an impact on the tone of the conference. Dr Meldrum called on the Department of Health to look closely at the Scottish model.

As the week goes on, the debate will make the headlines. The FT’s Nicholas Timmins is here, writing about doctors’ views on the co-payment issue. Interestingly, there seem to be a range of views. Hamish Meldrum sounds as though he is against their introduction. He told the Sunday Telegraph he was opposed to patients being allowed to "top-up" their health service care by buying life-extending drugs that the NHS will not fund. "My gut instinct is that this goes against the sort of NHS I believe in, which is free at the point of use, fair and equitable to all”.

The Telegraph says, Dr Meldrum stressed that his views were personal, and not necessarily shared by his members, who will vote on the issue at their annual conference. They will debate the issue on Wednesday, and I will be there to report it.

Writing in today’s Telegraph, columnist Janet Daley suggests that the Tories are blocking reform in health policy while Labour are pursuing it. Rather than just seeking to please the BMA, Conservative policy should be radical, she says: the co-payments issue is one where the Conservatives could make their mark by supporting change.

Expect co-payments to be discussed heavily this week.