Defining rationing… according to the patient.

If you cannot get the service it is rationed. If you don’t know in advance, and especially if other can get it elsewhere in the UK, it is unfair.

Definitions are available: (HealthKnowledge), and Politicians do not understand it. (Think tank calls for NHS ‘devolution revolution’ framework)  This suggests greater post-code rationing.

Little boy reaching for top shelf of rationed food

Dennis Cambell in the Guardfian 5th July 2016 warned: NHS finance chiefs warn of poorer care and longer waiting times – Rationing of services likely as hospital chiefs say they can’t make savings vital for reform and Sarah Bosely reported 28th July 2016: NHS ‘abandoning’ thousands by rationing hepatitis C drugs 

Sam Lewis comments on “rationing” that the “Keyword here seems to be “reported”, since all US doctors ration health care according to cost, by definition of its payment regime. As indeed do all UK doctors by virtue of the implicit provision according to affordability, NHS or not. “Rationing” needs specific definition to make sense.”

Rationing can be explicit or implicit, can be covert or overt. In his book “In search of the perfect health care system”, Mark Britnell agrees that all health is rationed, and that most services are covert in their rationing.

The degree of rationing, and the honesty with which health is rationed is what interests me, and in this regard the “patient centred” health service should, in the view of NHSreality, use words and language that the public understand: not the language of the medical profession. Prioritisation, exclusion, restriction etc. are all methods of rationing, as are co-payments and excess (as in you pay the first part of a car claim). What seems to be honest is when patients are aware of what is not available, and acknowledge that this is a necessity in running any health system. Once this is agreed, then the debate on how to ration, and whether rationing should be income/wealth related can also be discussed. It is naïve to say as the Independent 2nd August “Time for the NHS to learn that prevention is better than cure”

Dennis Campbell in the Guardian 2nd August reports: PrEP rationing is symptomatic of NHS bid to cut costs, at all costs  and NHS can fund ‘game-changing’ PrEP HIV drug, court says

If PrEP is a ‘lifestyle drug’, then so is my NHSfunded contraception

Nick Ferrari: Counting cost of £20m HIV drug

And there are of course other calls on £20million: £20m funding gap in Sheffield’s flood defences and Ofsted pressure triggers £20m funding gap. In the real world difficult choice have to be made and we ask our experts on health boards and in central government to do this. But is remains covert and implicit rather than overt and explicit.

Laura Donelly in the Telegraph reports 8th August 2016: NHS rationing set to worsen in attempt to close £22bn funding gap NHS treatments will need to be rationed and hospitals closed unless the health service makes unprecedented efficiency savings, a leading think-tank (Nuffield Trust) has said.

A new year. The Choice: Truth or evasion. Another election campaign without focus on the patient (“patient reported outcome measures”). More short termism, denial and political cowardice. No philosophy will be heard…

Rationing without agreement: Shadwell GP practice with 11,000 patients facing closure due to funding cuts

Cancer patients denied drug – restriction, prioritisation or rationing?


This entry was posted in A Personal View, Post Code Lottery, 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.

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