Rationing In The NHS Leads To Inequality In Access To Healthcare

Posted By Moosa Duke - 26th March 2013

Figures show that the availability of common surgical procedures across England vary due to restrictions put in place by some Primary Care Trusts (PCTs).

Due to the costs of surgery, research shows that the number hernia repairs, hip and knee replacement, cataract and varicose vein operation are restricted by some PCTs. Researchers say that this has led to a “postcode lottery” and may become problematic when the changes to PCTs come into effect in April 2013.

A study comparing PCT data showed significant variations in the number of operations being performed in some areas as some PCTs have implemented funding policies which provide a threshold for the number of clinical referrals made. For example in PCTs where cataract surgery was required, if rationing was in place, the PCT admitted less than 48% of patients compared to PCTs with no restrictions in place. In 2006- 2007, when rationing for hernia surgery was introduced, fewer than 59% of patients were operated on in comparison to other PCTs without a policy in place.

Since 2010-2011 this gap has narrowed although there are still significant variations depending on your local PCT.

The study entitled “the extent of rationing of surgical procedures in England” summarises the findings and states that whilst rationing is not necessarily good or bad, consistency is important but not present in the current system. The study concludes that national guidance should be provided and looks to the National Institute of Health and Clinical Excellence (NICE) for this.

The Department of Health maintains that “access to services should not be decided on cost” and the decision regarding surgery should be decided by medical experts on the basis of individual need. They have conveyed to the NHS that access to services should not be restricted on the basis of cost as it compromises patient care which is not acceptable.

However with the advance of clinical commissioning groups, which will take over from existing PCTs in April, it is very possible that there will be greater inequality in access to healthcare.