Making cuts in health services without involving politicians in discussion or debate about why!

As far back as 27th October 1995 the Independent reported; Health bosses ‘agree NHS rationing is inevitable’

The latest cuts have been made by politicians , without making tough choices themselves, and by denial and leaving the interpretation of the philosophy to the minister himself. It is politicians who are responsible for the abdication of any responsibility to discuss what is essential and what is desirable and what could be “self care” – in other words a pragmatic solution to our Regional Health Services, using ethical and educational arguments… We are making cuts in health services without involving politicians in discussion or debate about why!

Julia Hartley-Brewer in the Independent 31st July 2015 opines: The latest NHS cuts aren’t about health. They’re about blame – Tough choices don’t just have to be made by doctors – they have to be made by patients, too

Right, pay attention everybody. We’ve some tough choices to make. The NHS has to make £22bn of efficiency cuts by 2020, so where shall we start?

Do I have any bids for cutting children’s cancer treatment? Anyone? No, I thought not. What about knee surgery for the severely obese, or nicotine patches for smokers, or IVF treatment for infertile couples? Do you think we can get away with cutting those?

These are precisely the sorts of conversations that – like it or not – are going on right now within the health service. Our beloved NHS, created in 1948 to care for us from the cradle to the grave, has become a bottomless money pit. And it’s all our fault.

For a start, we’re all living a lot longer (tut tut, you selfish octogenarians), and many of us are eating too much, and then those pesky scientists among us keep coming up with new and clever ways of keeping us alive. It all costs money: £115bn a year, to be more precise. The £22bn of spending cuts will have to be found from somewhere.

An investigation by Pulse magazine has revealed that, to make the cuts, doctors are now “rationing” treatments such as hip and knee replacements and vasectomy operations – and even the fitting of hearing aids – in a bid to cut costs. A number of NHS Trusts have imposed stricter eligibility requirements for some of the most common operations, insisting that patients lose weight or give up smoking before surgeons will operate, while many trusts already limit access to expensive, non-emergency treatments like IVF. The truth is that these cuts aren’t just about simple pounds and pence. They are about assigning personal responsibility and – yes – blame. The question asked by the NHS is no longer “are you sick?” but “are you the deserving or the undeserving sick?”

What seems cruel and heartless to one is common sense for another. Most of us would probably not put an alcoholic top of the list for a liver transplant over another donor recipient whose liver had failed through no fault of their own. The limitations on hip and knee replacements are no different. After all, the single biggest reason why so many patients need new joints is because they are obese. Their bodies simply weigh too much for their joints to cope. The solution, then, is not expensive surgery but a trip to Weight Watchers.

The issue at the heart of the problem is whether we believe obese people, or alcoholics, or drug addicts, or smokers are to blame for all their ills and therefore not as deserving of free treatment on the NHS as someone who has led a healthy lifestyle but is then, say, diagnosed with leukaemia. While cancer sufferers may be high up on our list of “deserving” patients, 40-a-day smokers who get lung cancer or sun worshippers who get skin cancer are perhaps a little further down. It all comes down to whether it’s your own fault. But where does this end? And what’s next? Do we refuse to treat NHS patients, or charge them, if they cannot prove that they eat their required five fruit and veg a day? If we’re going to play the blame-game, what about people who ride horses or play rugby and get head injuries that could so easily have been avoided?

Making cuts to NHS spending will mean tough choices for politicians and our doctors; it may well mean tough choices for us patients too.

The Independent 31st July 2015: Leading article: The wrong sort of NHS rationing

Tony Yearman in the HSJ 29th July 2014: Removing the NHS ringfence: the next stage for healthcare rationing and in the same journal Crispin Dowler reports 15th Jan 2013: Commissioners have rationed cataract surgery on inferior evidence, Keogh admits

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

One thought on “Making cuts in health services without involving politicians in discussion or debate about why!

  1. Pingback: NHS to begin denying people hearing aids for first time – politicians will still deny it…. | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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