In an era of constrained funding, the long-term sustainability of the NHS in its present form is in question. People are living for longer, often with more complex long-term conditions. Patients’ expectations about which treatments they should be offered free on the NHS remain high. Costs are rising faster than the funding and services are adjusted to balance budgets.
The question of which treatments and services to fund has become an increasingly tough set of choices for national and local commissioners. The mechanisms through which these decisions are made are often contested – recent decisions by some local Clinical Commissioning Groups (CCGs) to restrict treatments have been met with outcry. At a national level, decisions made by NICE are frequently questioned, and politicians speak out against the ‘rationing’ of the NHS.
Everyone is agreed on the need for responsible and reputable choices. So what is the best decision-making process? Who is best placed to make these decisions? And is it inevitable that rationing will take place, as the finances are further squeezed and greater responsibility for decision-making is devolved to local CCGs?
We hoped to generate a lively, interactive debate to shine a light on these challenges and discuss how best to make these priority-setting decisions within a tax funded and constrained budget. Key questions we explored included:
- Why is there local variation in the NHS and is it fair that in one part of the country a patient cannot receive a treatment that is available elsewhere? Is a certain amount of local tailoring of what care is funded – in order to respond to different local needs – acceptable within a national health service?
- Is the way that NICE and the Cancer Drugs Fund work fair and appropriate for national rationing decisions?
- What role should politicians play? Is it acceptable for politicians to publicly state their opposition to rationing when giving every patient every treatment they wanted would bankrupt the NHS?
- And is there a better way of making decisions on which treatments to fund or is the current approach the right one?