The Government and NICE. Income and expenditure. Rationing by exclusion – but covertly

Expenditure is in the news, particularly on Social Care. Two years ago it was predicted: now it is reality (Tejvan Pettinger in economics 5th Dec 2014).  In “Unsweetened medicine” on Kick-starting the economy, particularly the economy in Wales or Scotland is not easy. NICE which has technically been rationing since its inception, may have to reduce it’s cost effectiveness thresholds if the chancellor has it wrong. Their work has also been undermined by the “cancer drugs fund” (Sarah Boseley in the Guardian 5th Feb 2016: Government has no idea about Cancer Drugs Fund’s impact, MPs say ).

Crossing the line (BMJ2016;352:i1336) written by John Appleby makes it clear that if the chancellor is wrong the “threshold” for “Quality Of Life Years might have to be reduced.. His graphics on rationing are at the foot of this post. Rationing by exclusion – but covertly is happening now, but it is addressing high value low volume items. NHSreality wants the nation to address low value high volume items as well.

The chancellor has little room for manoeuvre and doesn’t want to remind us again and again that we are overspending.  In The Times 22nd March 2016 you can find the latest expense graphic:

Expenditure 2016

But income is stagnant or falling and as (arguably more) important.


So we have a deficit. And Social Services takes up more than Health in the first graphic. Savings there are important.

There are complex rules for disabled people getting funds, and their interpretation is different in each region (Post code rationing), especially in dementia care:

Complex rules

The future planned by the chancellor on receipts and expenditure depends on a working population, and in the poorer regions this amounts to public servants. The Greek solution over many years was to appoint more public employees to get short term PAYE tax receipts. Tax avoidance by the self employed and the private industries is an impossible problem there:


The jobless total is falling and the accelerating slope of the curve since 2011 is impressive.

So will Quality Of Life Years” value index need to be as changeable as the budget? John Appleby’s graphs are below. If we don’t produce, or expand the economy we should all know what will happen. In parts of the nation with highest unemployment votes will go to those who promise more benefits and the nation gets more and more polarised.





This entry was posted in A Personal View, NHS managers, Patient representatives, Political Representatives and activists, Post Code Lottery, Rationing, Stories in the Media, Trust Board Directors 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.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s