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Conditional gifts for the NHS

The Royal Bank of Scotland has donated a state-of-the-art three dimensional CT scanner to an Edinburgh hospital, but with strings attached. The scanner will be available for use by NHS patients, but the Bank wants its staff to have priority access to up to 25% of the scanner’s capacity.

Some politicians and academics are opposed to the gift. But would there be good grounds for rejecting it?

One objection to the donation is that, given the strings attached, it doesn’t really qualify as philanthropy. That may be so. And it may be that RBS would have acted more morally if they had made the gift unconditional. Nevertheless, it might still be a good thing that the gift was made. Compared to existing technology, the scanner will allow more accurate diagnosis of some heart and brain conditions with much lower exposure to radiation. The fact that RBS could have acted better does not show that they acted badly.

A second objection is that the gift will introduce an arbitrary inequality in access to health care: RBS staff will have better access than others, and this might be thought unfair. But the gift will, plausibly, be pareto improving, making some people better off and no-one worse off. Any many would judge that increases in inequality ought to be avoided only when they make some people worse off than they would otherwise have been.

It is an interesting question, then, whether some people will be made worse off by this gift. If the NHS would otherwise have purchased the scanner itself, then perhaps they will. Some NHS patients may be denied access to the gifted scanner, thought they would have been able to access an NHS-purchased scanner. But then, if the NHS had purchased the scanner itself, it would have had to divert resources from alternative health care uses, thus disadvantaging other patients elsewhere. Moreover, it seems unlikely that the NHS would have purchased the scanner if the RBS had not donated it.

The gift could also potentially make some future people worse off. One fear underlying some criticism of the gift seems to be that the government may come to rely on similar conditional gifts, reducing its own funding for healthcare. The result might be a system providing a similar total amount of healthcare to the current system, but distributing access to that healthcare less equally. Other things being equal, those without special priority access under the conditions of the gifts would, in this future system, be worse off than under a wholly state funded system.

This is a legitimate worry. However, it seems likely, however, that any negative affect of the RBS gift on future government funding of healthcare would be relatively small, and thus outweighed by the immediate benefits of improved diagnostics. More problematic cases may arise in the future, however. What would we say to a CT scanner offered on the condition that 90% of its capacity would be reserved for a particular group, or that priority access will be given to members of certain religious or racial groups? Given such possibilites, calls further further debate and firm public policy on the matter may well be warranted.

News Stories:

Melanie Reid,  ‘Opponents object to bank’s CT scanner donation to NHS‘, The Times, 26 May 2008.

BBC, ‘Call for debate on NHS donations‘, BBC News, 26 May 2008.

Channel 4, ‘3D heart and cancer scanner used‘, Channel 4 News, 26 May 2008.

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