We need to go back to Aneurin Bevan and re-examine the fundamental reasons for the UK health services. We all pay under the same tax regime and should have universal fair and equal access, but this does not mean rationing out some services is impossible.
Rationing by post-code exclusion, covertly, and in a way that means patients are unaware of the lack of cover until they need it is morally wrong.
The only fair way is overt rationing. Since technology will continue to outstrip the states ability to pay there will also be some low volume high cost treatments we have to ration or exclude. Our system needs to be good enough, and with short waiting lists, so that these conditions are as few as possible.
Identity cards giving access to health care, and at the same time tax codes, could be used to create differential co-payments. These might be accepted if the standards were high, there was meaningful choice, and if waiting times were low. The opposite is true at present, and the under capacity looks to be getting worse.
The result of training too few of our own, and importing form abroad is disillusion. Short termism in political thinking has led to a crisis which will get worse and result in two tiers of health: state and private and the dishonesty has disengaged the professions. This is exactly what Aneurin Bevan wished to avoid.
Kat Lay and Tom Wills, Times Data Team report in the Times 3rd July 2017: Patients in same
street get different NHS care
Patients are facing a lottery of services from GP surgeries even within the same postcode, a Times investigation has found.
People attending different GP practices in the same building face huge variations in waiting times for the same procedures, the analysis shows.
Choosing one practice over another could influence whether it is possible to have a baby after fertility treatment, or mean waiting five weeks longer for knee surgery, according to the study.
The Times data team analysed the addresses of all English GP surgeries and found 120 pairs within 500 metres of each other that were governed by separate clinical commissioning groups (CCGs), the GP-led bodies that decide what the NHS will pay for locally.
Many had identical postcodes and all are thought to accept patients from the same or overlapping areas, but provision varied wildly within the pairs.
Some of the starkest variations occurred in fertility treatment. At the Museum Practice in Camden, north London, patients can have three cycles of IVF. However, 327 metres away, patients at Covent Garden Medical Centre would be offered only one. The discrepancy occurs because of different policies followed by Camden and Central London CCGs.
Infertile patients at Bawtry Health Centre, near Doncaster, will be offered three cycles of IVF, but patients at Mayflower Medical Practice in the same building will be offered two.
Waiting times for treatment can also vary, in some cases by months. In Birmingham, Modality Attwood Green is on the second floor of the same building as Bath Row Medical Practice, which is one floor down.
Bath Row comes under Birmingham South and Central CCG, where patients requiring general surgery face an average wait of 12.4 weeks. Modality Attwood Green is governed by Sandwell and West Birmingham CCG, where the waiting time for general surgery is 7.4 weeks.
On Stroud Green Road, in Finsbury Park, north London, the Stroud Green Medical Centre and the 157 Medical Practice are a few doors apart. The former comes under Islington CCG, with an average 11.8-week wait for general surgery, the latter under Harringey CCG, where the general surgery wait is 7.4 weeks.
A spokesman for the Royal College of Surgeons said: “It will no doubt surprise and anger people to discover that patients visiting GP practices in the same building, or indeed very near by, could have different access for surgery . . . Commissioning groups must investigate why their waiting times are so much longer than their neighbours.
John Kell, head of policy at the Patients Association, said: “Expecting patients to have the understanding of the system needed to navigate these complexities, for instance by choosing a GP practice based on the CCG it sits under, is obviously ridiculous.”
Chaand Nagpaul, chairman of the BMA’s GP committee, said that the “arbitrary drawing of lines on a map” to create CCGs had led to “a serious and unfair postcode lottery”.
Under the Health and Social Care Act 2012, CCGs are responsible for paying for the NHS care of any patient registered at any of their member GP surgeries, but can set their own policies on what they will fund.
Susan Seenan, chief executive of the Fertility Network UK charity, said: “This highlights how utterly unfair access to NHS fertility treatment is in England. An individual’s choice of GP practice should not determine the medical help they will receive and yet, this is what is happening: if you register with one GP you will have a chance to have a baby with IVF, but if you’re unlucky enough to choose another practice you will not.
“Sadly, not all patients realise that their choice of GP practice can determine whether they receive fertility treatment or not, or how much clinical care they receive.”
Under a “capped expenditure process”, local NHS leaders have been told to consider further cuts. Measures could include extending IVF limits or increasing waiting times for elective surgery.
Julie Wood, chief executive of NHS Clinical Commissioners, said that commissioners had to take into account the needs of the local population and their finite funding so it was “right and inevitable” that there would be variation in provision. She added: “We appreciate this can be difficult for some patients, and particularly sharply felt when relating to neighbouring areas.”
Behind the story
Most patients choose their nearest GP but few realise that this can influence which treatments the NHS might offer (Chris Smyth writes).
When people use an NHS hospital, the bill is sent to their GP’s clinical commissioning group. The groups control £77 billion of NHS cash, deciding what care they will pay for.
Created by Andrew Lansley’s reforms in 2012, GP-led commissioning groups were meant to allow doctors to use this clout to tailor services to their patients’ needs. Yet an NHS squeeze has meant that cost control has become an ever-bigger part of decisions. Stories abound of CCGs cutting back on fertility treatment, curbing surgery or restricting care for the obese and smokers.
Few patients shop around for a group with a favourable approach to fertility treatment, for example, but they have that right. They are entitled to register with any GP, providing the surgery is willing to accept them. Treatment decisions would then be taken by that practice’s CCG. The right to choose a GP for reasons other than proximity is not widely exercised, but some may soon feel it is worth their while.
Everything for everyone for ever for free?