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Can rationing of cardiological services be rational?

In the United Kingdom there is a pervading perception that provision of health resources has not kept up with the availability of effective clinical procedures. By international standards expenditure on health services expressed as a percentage of gross domestic product remains low.' To clinicians the system feels increasingly tight financially because resources are not available to meet expressed clinical demand. This is particularly true of cardiology and cardiac surgery where the National Health Service (NHS) can no longer afford many effective treatments for all who might benefit from them. This harsh fact is often a source of disappointment and frustration. It can also cause conflict between professional groups who struggle to maintain their own service needs against competing interests. Is the problem inevitable? If it is, can we distribute resources in a manner that is seen to be equitable and fair?