NHS rationing growing, Dr Foster has found
Elliot Bidgood, 10 December 2013
Dr Foster Intelligence, which provides information on NHS performance, released its Hospital Guide 2013 yesterday. Among their findings was evidence of increased rationing of key cataract, knee and hip operations – Dr Foster found numbers of operations performed each year has levelled off or fallen very slightly since 2010, breaking from a previous long-term trend of population ageing-driven rises. More hip replacements are still being performed each year, but the rate of increase has slowed. This follows allegations of age-based rationing I noted in September and Dr Tony Hockley’s finding for Civitas that treatment for certain rare, life-threatening diseases was under threat back in May.
Cataract, knee and hip operations are said to be “highly effective” in terms of impact. Cataract operations, for example, prevent costly re-admissions due to accidents and were described by the Professor Harminder Dua of the Royal College of Ophthalmologists as “the most cost-effective procedure on the human body”. Dr Foster’s data has also demonstrated that rises and falls were inconsistent across different parts of the country.
These findings are largely consistent with a Civitas report I wrote last year. It noted that official Hospital Episode Statistics (HES) data for 2010-2011 showed slight falls in the number of cataract and kidney transplant operations after years of rises. I also found that then-Primary Care Trusts (PCTs) had varying policies on “Procedures of Low/Limited Clinical Value” (PLCVs). Some PCTs published statements that were laudably upfront with their local populations about the difficult budget determinations that had to be made, though I felt this could be more standard. Officials I spoke with from the Royal College of Nurses, Royal College of Surgeons and the British Medical Association also brought attention to anecdotal evidence of greater rationing.
Worryingly, from comparing reported PLCV restrictions with local budget allocations, I also discovered that the Department of Health’s budget allocation formula may not have been consistently preventing PCTs with higher-need populations from being more affected by rationing.
Rationing is effectively a historical reality in the NHS, but this current rise is the result of the acute funding strain caused by the onset of austerity since 2010, despite the nominal ‘ring-fence’ the service benefits from. I would note that Dr Foster also found that utilisation of “less effective” procedures (tonsillectomies, knee washouts, back pain injections) has fallen overall by 9%, however, suggesting the NHS is responding by prioritising and protecting more clinically important procedures as much as possible.
Nevertheless, a 2012 poll showed that 85% of GPs believed the Department of Health should consider setting out comprehensively “what is and what is not available to patients” on the NHS. Difficult though it will be, there may well come a time when it will be within the public interest to heed this call and make expectations clear.
For more of our work on health, including books and research papers, visit our website here.
Here’s a proposal to free up £50 billion from current expenditure to fund the NHS, pensions and long term care properly.
1. End foreign Aid – saving £11 billion.
2. Reduce the per capita Treasury funding to Scotland, Wales and NI to that of England – Saving £17 billion.
3. Leave the EU – saving £20 billion. Much of the money the UK gives to the EU comes back from Brussels but it is only spent on EU approved programmes, many of which require matching funding from the UK.
4.Strip out all politically correct driven policy from publicly funded organisations – difficult to give and exact figure but it would be substantial because all public bodies have to by law prove that they are not discriminating on the grounds of gender, race or sexual inclination. The Met Police boasted five or six years ago that they spent over £7% of the budget on “diversity and gender” issues.