Is health rationing the answer?

Health Week
By David Fenton
BBC South Health Correspondent

The NHS cannot pay for every treatment that every patient wants. But does that mean that healthcare has to be "rationed"?

The health secretary said Herceptin should not be refused due to cost

There is disagreement over whether denying some treatments and allowing others is actually rationing.

Those who say it is argue that the money available for healthcare is finite - whereas the healthcare demands of society are not. Given that there will always be more people demanding more treatment than there is money for - healthcare must be rationed.

Opponents argue that this is not rationing - but "cost containment". In other words, setting a limit on how much should be spent on health, and then doling it out accordingly.

What is clear is that the arguments about this are becoming increasingly important - both inside and outside the NHS.

Open debate

A recent survey by the BMA found that 96% of doctors believe it is time for an open debate on rationing in the NHS. Also, many of those doctors believe that patient lifestyle should play a part in how healthcare is rationed.

Doctors were asked if they agreed with a decision by a local health trust to stop performing joint surgery on obese people - partly because it is less likely to be successful but also because the trust wanted to cut costs.

Four in ten doctors believed joint surgery should be refused to obese patients. Others thought smokers and excessive drinkers should also be denied certain clinical procedures.

Of course - that is the view of one group of health professionals. Patients - who have paid into the NHS all their lives - may view their local hospital refusing them surgery because they smoke quite differently.

This begs the question, if there has to be rationing - who should make the decisions?

I am not going to just sit at home and wait to die if I know there is a drug out there which can help me Anna Roberts

At the moment there is no simple answer to who decides who gets what. On the face of it, primary care trusts "buy" a certain number of operations and clinical procedures from hospitals according to needs of patients living in their area.

The National Institute for Health and Clinical Excellence also makes decisions about health rationing in England and Wales. It is their job to decide which treatments are cost effective and should be prescribed on the NHS.

But the case of the cancer drug Herceptin shows how things can change. Herceptin is a new and seemingly very effective drug for treating breast cancer. It costs about £20,000 a year per patient.

Many health trusts told women that they could not have it and it appears that cost was part of the issue.

'Right to treatment'

After a legal challenge by a patient demanding the drug - the health secretary decreed that health trusts must not refuse Herceptin just because it is expensive.

An immensely popular move with the many women waiting to get the drug, but health trusts now face having to find tens, even hundreds of thousands of pounds for Herceptin, which can only come out of existing budgets.

Anna Roberts, who lives near Chichester and is now receiving Herceptin, summed up the dilemma which the health service, and society, now faces.

"I am not going to just sit at home and wait to die if I know there is a drug out there which can help me,' she said.

"And I don't see why we should be made to feel guilty about getting this drug. We have as much right to treatment as anyone else."

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