Rationing

We are all aware that the munificence of the NHS system is not unlimited. Nor has it ever been. The system is and always has been rationed. Countless people wish that it weren't but those countless people are not prepared to pay all of their earnings into the system: and it could absorb the entire GDP of the UK and still not be able to guarantee an unrationed system.

How the rationing that is a fact of NHS day to day adminstration is exercised is a matter worthy of public debate but such debate cannot happen unless and until the need for rationing and an acceptance of that rationing is accepted by the NHS users: the electorate. In the meantime we will continue to have alarmist news items about post-code rationing and more importantly the adjudications of N.I.C.E who are seen as the main rationing body in the system.

My own preference would be to come up with some logical equation for each treatment-patient pair: one that balanced improvement in life quality (quality improvement years) , against cost per treatment, against likely positive outcome, against  x, y, and z - (I don't have or expect to have a definitive list).

Whenever this debate comes up I am reminded of a decision that a friend of my sister, a consultant surgeon, took some time ago. It was around the time of the first few heart transplants. He resigned as a consultant surgeon and has, as far as I know, never practiced medicine since. HIs problem, as he explained it, was that a heart transplant would cost perhaps £10,000 and involve x weeks in hospital, plus the cost of anti-rejection drugs for the rest of the patient's life whereas for that amount of money and other NHS resource investment he could perfom perhaps 20 or 30 hernia operations that would significantly improve the quality of life for all those patients for the rest of their natural lives. He could not countenance that trade off and left the profession.

The revelation today that an ex-MP is fighting to have prescribed to her drugs that might save her sight LINK while fertility treatment and trivial cosmetic surgery is widely funded by the NHS brought the argument into focus again (forgive the pun).

A public debate is overdue. An informed public debate. But in order for that to happen we have to confess to the need for rationing first and that doesn't seem to be a debate that anyone is keen to have - least of all big pharma.