Some while ago I heard a senior administrator give a rather unsatisfactory lecture on the topic of the distribution of resources within the Health Service. It was unsatisfactory not so much because the message of the lecture was that decisions in this area are extremely difficult to take; but because the speaker seemed to think that the repeated insistence of this point would do in lieu of an attempt to state the principles which govern or at least should govern the practice.

Decisions about the distribution of resources within the Health Service are important decisions for the obvious reason that the provision of funds for health care does not and could not meet all conceivable claims which might be made upon the budget. The Beveridge Report proposed that ‘a comprehensive national health service will ensure that for every citizen there is available whatever medical treatment he requires in whatever form he requires it’, but no matter how well funded, no health service could be comprehensive in this sense. Governments, civil servants and administrators are obliged, therefore, to allocate resources between the various specialisms deciding how much is to be devoted to neonatal care, how much to transplant surgery, how much to the care of the elderly, and so on. These decisions are no doubt extremely difficult, but this is all the more reason to think that we should seek to make them in an informed and principled way.