NHS treatments: what would you prioritise?

There is nothing new about treatments being rationed in the NHS. It is the nature if the beast that means the pot of money is not endless.  Indeed, a couple of years ago we produced a map of England’s primary care trusts where operations were being cancelled or not allowed. It was widespread and worrying but not universal. It was also beginning to drive a postcode lottery.

We discovered in one area a patient told to move over the (invisible border) to her mother’s where she would be able to get IVF because her own local authority had put the finding on hold and nobody was certain when or if they would be reinstated. Cataracts, hip operations and varicose vein removals were also being restricted.

But now GP magazine has revealed that 90 per cent of trusts in England are now restricting procedures. And they are blaming it on cost cutting and the need to prioritise care. The government’s response was to say there was no justification for this. The health minister, Simon Burns, said it was “unacceptable”.

There are many health service pundits who will, however, not be surprised by this.  It was, some would say, not a matter of “if” but “when”.  Demanding the NHS makes £20bn savings and at the same time introducing massive reforms was inevitably going to increase the pressure. And it is too tempting for health service managers to ration in order to maintain other services.

The Health Secretary Andrew Lansley has insisted that all the money trusts have been told to save will be ploughed back into the NHS. Health service funding is so unbelievably complex, that is a hard one to keep track of.  But what many in the NHS would like is a discussion with the public about rationing. Rather than instituting it, which inevitably leads to bad headlines and furious patients, why not ask people for their views on what should go and what should stay?

One such patient recently said to me that the refusal by his PCT to fund a treatment for his severe dystonia had been refused while people were being given gastric bands for their obesity. But is it as simple as that? No government has yet agreed to such a debate but as the commissioning or purchasing of healthcare by our GPs is about to be introduced, what we can and cannot have is a discussion coming ever closer to us anyway.

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