NHS to 'extend rationing' of healthcare in bid to balance books
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Version 0 of 1. The NHS plans to dramatically increase rationing of patients’ access to care and treatment in an effort to balance its books, a new survey of health bosses reveals. Almost two in five of England’s 211 clinical commissioning groups (CCGs) are considering imposing new limits this year on eligibility for services such as IVF, footcare and hip and knee replacements. Smokers and those who are obese will be among those denied surgery and other treatment, according to a survey of 80 CCG leaders conducted by the Health Service Journal, in an extension of the controversial policy of “lifestyle rationing”. Related: How to save the NHS – by the people who work for it Chief executives, chairs and board members at 67 CCGs were asked: “Is your CCG considering introducing new limits to access/eligibility for services during 2015/16, for financial/efficiency/value reasons?”. Among the respondents, 39% said yes, 57% said no and 4% didn not know. The 211 CCGs, set up in 2013 by the coalition’s NHS shakeup, control how £69.2bn of the NHS in England’s overall £101bn budget will be spent in this financial year. The NHS ended 2014-15 an estimated £1bn in the red for the first time since 2005-06 as hospitals and other local NHS bodies struggled to keep up with a rising demand for care and the need to hire thousands more staff to ensure high-quality, safe care in the wake of the Mid Staffs scandal. NHS Providers, the health trusts’ association, has predicted that the deficit will grow to as much as £2bn-2.5bn by the end of 2015. Jeremy Taylor, chief executive of National Voices, which represents 140 health charities, said the plans were very worrying and would threaten the NHS’s status as a service that treated patients based on their clinical need. “It’s very worrying to hear this because access to services that people need is a key aspect of what makes the NHS the NHS. It’s comprehensive, it’s national, it’s free at the point of use and it’s not based on ability to pay, so if you want to ramp up rationing then you call into question the extent to which it’s still a comprehensive service based on clinical need. This is worrying but not surprising, given the overall financial state of the NHS”, said Taylor. Asked for examples of the sorts of new restrictions they were considering, CCG bosses said they were looking at extending their use of lists of “procedures of limited effectiveness”, which have proved controversial, with surgeons, in particular, claiming they wrongly deny patients care. They also mentioned discharging some patients from podiatry services, having thresholds for joint surgery, introducing clinical thresholds of need for some operations and limiting either access to IVF or the number of cycles a woman can have. Some cited “limiting access relating to health outcomes, for example because of smoking and obesity/body mass index” and the use of “referral management” schemes, whereby panels of doctors decide who should or should not undergo a certain procedure. The Conservatives said they would stop CCGs imposing such rationing. “If local health bodies stop patients from having treatments on the basis of cost alone, then we will take action against them”, said a party spokesman. He urged Labour to “say where they will find the money to ensure patients get the treatment they need.” The Tories have committed to giving the NHS the extra £8bn that the NHS England chief executive, Simon Stevens, has said it will need by 2020. Andy Burnham, the shadow health secretary, said increasing rationing was forcing more and more patients to pay for care that would previously have been free. “Across the NHS, we are seeing a widening postcode lottery in access to treatment as financial pressures set in. The impact of this rationing plan is to expose the public to a greater range of charges for healthcare. I wrote to Jeremy Hunt about these concerns but he has failed to act. “At the same time, he has encouraged hospitals to fill half their beds from treating private patients. This has left thousands of older people facing the appalling choice of suffering in silence or paying to use NHS beds.” |