Precedent? Rationing becomes reality to politicians in Scotland. Now to work out how to do it best?

Its ironic that Scotland is short of doctors, GPs especially, when it trains more per capita than any other UK region. Rationing is becoming reality to politicians in Scotland. Now we need to work out how to do it best?

This is such an important precedent. Health Boards are an arm of government. If this “decision” to ration overtly is not challenged by Westminster, then the  other 3 UK Regional Health services can go ahead and ration overtly rather than covertly. Once accepted then the principle applies that we need to be universal over important expensive treatments (such as cancer), and to avoid post-code rationing whenever possible for “fearful” conditions. Rationing will be needed at the top (expensive) and at the bottom (cheap and high volume) end of care. We might agree to pragmatically accept post code differences at the bottom end but surely not at the top end. Now lets hear from the politicians…

on April 3rd 2017 in the Times Scotland edition Helen Puttick reports: System for rationing NHS care developed for Scottish boards

A scoring system for rationing hospital and social care is being developed for care boards in Scotland.

The £250,000 initiative, similar to that used by drugs watchdogs, will pay for a team of economists to create a framework that the NHS and councils can use to decide where to cut funding in services and where to invest.

The move, supported by the Chief Scientist Office, is part of the drive to shift spending away from hospitals into the community to prevent ill health and look after the frail elderly better in their own homes.

Scotland’s new care boards, which manage both community NHS and social care services, could use the system to weigh up controversial decisions, such as whether to maintain a local hospital service or instead create a “hospital at home” team taking more treatment to people’s homes. It is intended to work in the same way as the Scottish Medicines Consortium in Scotland and the National Institute for Health and Care Excellence (Nice) in England, which make often-contentious judgments on which drugs are to be made available to patients on the NHS.

Professor Cam Donaldson, a health economist at Glasgow Caledonian University, who is leading the team, said difficult decisions needed to be made about which services were of most benefit to most people.

In any system that was free “the needs outstrip the amount of resources available” he said, and with the NHS and social care, “that has become an acute problem recently”.

“What we really need to put in place are more robust processes to help health and social care partnerships to manage scarcity,” he added. “Difficult decisions will need to be made in Scotland about which services to fund and to what extent, and which existing services to scale back.”

With little or no increases in global budgets, frameworks need to help shift resources “from low-value services . . . to higher-value services in areas of most need”.

Nice and the SMC evaluate new drugs to decide which the NHS should buy based on the amount of extra quality of life they offer for the price. Professor Donaldson compared the methodology his team will create to this system, but noted that there were some marked differences. For example, the new framework will have to consider where to cut expenditure as well as what to fund.

Professor Donaldson said that the results of a public consultation would also be a factor and the process would be transparent, ethical and have some form of appeals system.

Without such a framework, he said, there was a risk that “whoever shouts the loudest most recently” would receive funding. Resources, he noted, might have to be taken from services that were still productive but deemed less effective than other options.

The £244,000 funding will pay for the development of the system and for four care boards to test how well it works.

At a time when countries around the world are grappling with how to care for a growing elderly population, the research is seen as pioneering. Professor Donaldson said: “A study of this nature has never been undertaken before and would place Scotland at the forefront of this important field of social and economic policy.”

Donald Cameron, the Scottish Conservatives’ health spokesman, said: “Anything that could provide a fairer way for deciding what course of action to take with a patient certainly deserves to be considered. However, any system that is put in place must be equitable and would need to be regularly checked and updated to ensure that it is meeting the needs of patients.”

All main political parties’ pledges for NHS will prove inadequate, says former chief executive

David Lock in 2014 in the Guardian: Rationing NHS care: why we need a serious debate 


This entry was posted in A Personal View, Good News, 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.

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